Becker's ASC Review

80 QUALITY 60 patients sue Guardian Pharmacy & 2 Dallas surgery centers that used its drug: 5 insights By Angie Stewart S ixty patients are suing Dallas-based Guardian Pharmacy and two Dallas- area surgery centers that administered the company's compounded solution in 2016 and 2017, WFAA reports. What you should know: 1. e lawsuits allege Guardian's solution caused vision damage within weeks aer it was injected during procedures at Medical City Surgery Park Central, formerly Park Central Surgical Center, and Key-Whitman Eye Center. A Key-Whitman Eye Center spokesperson declined to comment on the pending litigation. Becker's ASC Review was unable to reach a Park Central representa- tive at the time of publication. 2. In May 2017, Park Central Surgical Cen- ter Administrator Rick Coffman, RN, signed a letter republished by Van Wey Law, which informed patients that some had developed vision impairment aer undergoing cataract surgery at the ASC. "We now believe the underlying cause of this issue may be an antibiotic medication used during surgery. e medication was prepared by an FDA-inspected laboratory here in Dallas and provided to Park Central Surgical Center," the letter said. 3. Van Wey Law identified the solution in question as triamcinolone/moxifloxacin. e law firm is representing cataract pa- tients who reported eye injuries. 4. Jeffrey Whitman, MD, previously told WFAA, "e medication was not made to specifications and that is what most likely affected the retina." 5. Guardian voluntarily stopped compound- ing the drug. However, Guardian Pharmacy President Jack Munn said in a statement to WFAA, "No scientific connection has been established by any entity between the drug Guardian Pharmacy Services compounded and the illnesses that have been reported." Note: ere are two separate, unaffiliated companies named Guardian Pharmacy Ser- vices. is article refers exclusively to the one headquartered in Dallas. e other is based in Atlanta and recently acquired Guardian Pharmacy of Dallas-Fort Worth in Arlington, also not affiliated with the pharmacy refer- enced in this article n Preoperative frailty assessments in ASCs — 5 insights from anesthesiologist Dr. Lee Fleisher By Angie Stewart L ee A. Fleisher, MD, is chair of Philadelphia-based University of Pennsylvania Perelman School of Med- icine's anesthesia and critical care departments. Dr. Fleisher is also chair of the American Society of Anesthe- siologists Perioperative Brain Health Initiative. Here, Dr. Fleisher shares his insights with Becker's ASC Review on preoperative frailty assessments in the outpa- tient setting. Question: Why is it important that ASC physicians conduct preoperative frailty assessment? Lee Fleisher: There is increasing evidence frailty may be the best predictor of how patients will do after surgery. It integrates a lot of other information and may be a bet- ter predictor of how someone is doing functionally. The METS trial (Lancet, 2019) demonstrated that anesthesi- ologists' prediction of exercise tolerance is very poor, so a more objective measure may be more predictive. Q: Which specialties or patient groups are most in need of preoperative frailty assessments? LF: The appropriateness and evaluation of surgery depends upon the surgery and patient comorbidity. For more invasive surgery, the appropriateness of having surgery performed on an outpatient basis may be less ideal because of the risks of going home and being readmitted or making sure that there are caregivers avail- able at home. Specific populations include the elderly, particularly with cardiovascular or pulmonary disease as well as cognitive impairment. Older patients should be screened, with an ideal age at 65 or 70, depending upon the population. Q: What types of pre-existing cognitive impairments put patients at high risk of delirium after surgery? LF: Any type of mild cognitive impairment puts patients at risk. Work by Debra Culley, MD, at [Boston-based Brigham and Women's Hospital] represents the best evidence to show that a poor score on the mini-cog was a strong predictor. Q: How should ASC physicians incorporate preopera- tive frailty assessments into their practice? What may be holding them back? LF: There is no clear best way to assess frailty since it has mainly been assessed in research studies. Incorporating the mini-cog can be done today. Q: What else do you want surgery center anesthesi- ologists know? LF: [I want them to know] that it may be appropriate to perform surgery for older adults with mild cognitive impairment, but caregivers should be warned about the signs or symptoms of delirium and delayed cognitive re- covery. This should include both hyper- and hypomanic delirium. n

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