APC greatly appreciates the level of surgical expertise present in the communities we service. We work tirelessly to collegially partner with our surgical friends to create an effective and safe surgical environment. We will always communicate any concerns and will work a plan with our surgeons for the best possible care of the patients. Our goal is to to bring best practice care efficiently while minimizing untoward side effects and pain in our patients.

Our acute pain management techniques are proven to reduce length of stay, decrease opioid use, and improve outcomes.  We have been leaders in the implementation of ERAS guidelines within our facilities. Our physicians work to provide leading edge pain management techniques to our patients including the use of regional anesthesia blocks, epidurals, TAP blocks, and alternate pain medications. 

Our teams strive for on-time starts and efficient room turnovers to achieve high surgeon satisfaction. Internally we actively monitor on-time starts and room turnover times and constantly work with our OR teams to improve these metrics. 

We believe in clear communication and a consistent best practice approach. Below is a partial list of recommendations and positions adopted by APC that may be helpful to you for surgical planning.

If you are a surgeon we serve and have any suggestions, complaints, or comments, please contact us in person or on the following form and it will be addressed in full with our team.

Standards and Positions adopted by APC:

NPO Guidelines:

  • Clear liquids – 2 hrs  (H2O, fruit juice without pulp, carbonated beverages, clear tea, black coffee plain)
  • Breast milk – 4 hrs
  • Infant formula – 6 hrs
  • Non-human milk – 6 hrs
  • Light meal – 6 hrs  (dry toast and clear liquids)
  • Regular meals – 8 hrs. (fatty foods)

Pre-Op Visit Recommendations

We recommend all patients undergo a screening prior to their day of surgery. This screening can be accomplished with a phone call in many cases. During this screening, a standardized protocol and scoring system will be utilized to determine if further work up or visit to the pre-op  clinic needs to be obtained. If there are questions, concerns, or a need to postpone you will receive a phone call with details and potential next steps to ensure minimal delay.

Pre-Op Lab Recommendations

We recommend that you only obtain labs and tests that you will require prior to surgery to avoid an overuse of laboratory screening exams. Our protocols will determine which labs and or tests we will need to obtain prior to the day of surgery. This approach will minimize unnecessary labs and or tests and help to avoid unnecessary delays.

Pre-Op Medications Recommendations

We will make specific recommendations regarding which medications, dosage, and timing after review of the patients preop visit information and communicate this to the patients

Recent URI recommendations

Urgent and elective surgeries warrant a evaluation to weigh the relative risks associated with proceeding with surgery vs waiting until URI resolves. Severity of illness, symptoms, and treatment options will be part of the evaluation. In general, a patient’s airways will remain reactive for four to six weeks following a URI, increasing the patient’s risk for pulmonary complications. We recommend rescheduling elective procedures (or at least a direct conversation between the surgeon and anesthesiologist addressing the relative risks of proceeding vs waiting.)

Epidural Candidates:

  • Platlet count > 100,000
  • Non-Septic Patient

General Anti-coagulation Guidelines for Regional Anesthesia:

  • Platlet count >100,000
  • Stop at least 7 days prior to surgery
    • clopidogrel (Plavix)
    • prasugrel (Effient)
    • ticagrelor (Brilinta)
  • Stop at least 72 hours prior to surgery
    • dabigatran (Pradaxa)
    • fondaparinux (Arixtra)
  • Stop at least 48 hours prior to surgery
    • apixaban (Eliquis)
    • rivaroxaban (Xarelto)
    • edoxaban (Savaysa)
    • abciximab (Reopro)
  • Stop at least 24 hours prior to surgery
    • Enoxaparin (Lovenox)
    • dalteparin (Fragmin)
    • aspirin/dipyridamole (Aggrenox)
  • Stop at least 12 hours prior to surgery
    • Heparin 7500 SQ Q8H
  • Warfarin (Coumadin) check INR < 1.5
  • Consult with anesthesiologist for alteplase (TPA), tirofiban (Aggrastat), eptifibatide (Integrelin), argatroban, bivalirudin (Angiomax)
  • Consult with anesthesiologist for any known coagulopathy or other extenuating circumstances