Mitigating Risk for Surgical Patients

The inception of gene: drug related interactions has driven the medication industry into an arena of not only tailoring medication management but an era that can reform healthcare outcomes and deliver a more manageable roadmap to patient care.

The Precision Perioperative Medication Risk Solution (PPMRS) looks at a number of known genetic pathways related to surgical medication, their appropriateness based on risk and genetics, and mutations that can cause complications during and after surgery. The goal of every test is to,

  1. Determine a patient’s risk for adverse drug events to these medications, including PONV.
  2. Risk around CYP2D6 metabolizer status,
  3. Ability to metabolize analgesia medications including opioids and non-opioids to better understand perioperative pain control.
  4. Provide practitioners and patients with a full picture of both the recovery path and future medication needs with genetics.

The knowledge contained within our evidence-based system can help anesthesiologists to deliver an appropriate medication plan for each patient to predict and prevent complications before and during. Our solution goes a step further to allow the patient’s practitioners access to the genetic interpretations for all medication the patient may be on, now and in the future, to ensure healthier and less risky outcomes.

Our Test

Precision Peri-operative Medication Risk Solution utilizes a PGx test by obtaining a simple cheek swab from the patient at least 2 weeks before surgery. The test provides valuable information that cannot be obtained from a patient history and physical examination alone. Precision’s genetic test evaluates the genes that interact with the drugs most commonly used during surgery. The test results help to assess the medication risk to the patient and inform discussions about the risks of existing therapies and benefits of using alternative options for surgery. Additionally, the test will help to predict post-operative complications that may arise due to existing conditions and medications the patient is on and establish a baseline measurement for continued care.
The type of PGx testing Precision Genetics preforms allows practitioners to understand if a patient can metabolize opioids. Not being able to metabolize opioids is part of our nations opioid epidemic. Know the opioid status of your patient BEFORE you prescribe and understand if a non-opioid alternative is a better choice.
There are documented clinical publications around the genetic risk of analgesics.  During surgery, the patient’s anesthesia provider will use several analgesic agents, including opioids and non-opioids. Commonly used opioids include fentanyl, morphine, and hydromorphone; less commonly used are remifentanil, alfentanil, sufentanil, and meperidine.  Knowing which one will work best based on genetic guidance will allow the patient to recuperate effectively in the PACU.

Problem/Challenges

While doctor-patient communication is a key determinant in adherence to many care plans, the importance of surgeon-patient communication is amplified by the invasiveness, risk, and complexity of surgical procedures. There is not only the procedure itself to consider, but a whole host of preoperative medication considerations, postoperative instructions, and medications to manage. Too often surgical patients suffer from adverse events and they often end up back in the hospital or in poor recovery due to the existing one-size-fits-all medication prescribing habits.

What Our Solution Provides

Our approach takes the guesswork out of how the patient will reach to surgical medications, whether they will suffer adverse analgesia episode and if the right medication choice is an opioid or a non-opioid for post surgical pain management. Medically necessary procedures are more popular than ever before due to the implementation of new non- or minimally-invasive techniques and tools allowing surgical procedures and patients recovery to be quicker than normal. As a medical professional, you understand the importance of knowledge and practiced skill when it comes to obtaining the most effective results. So, you owe it to yourself and your future patients to hone your surgical care plan.

Precision Genetics has developed an advanced commercial perioperative risk-assessment report with the objective of implementing:

  • Pre-operative medication optimization,
  • Intra-operative risk assessment and management, and
  • Oost-operative complication prediction and patient handoff.

Precision Genetics has developed a proprietary panel of peer-reviewed pharmacogenetics markers to accomplish these goals. Building upon a foundation of clinically relevant pharmacogenomic variants, we also include markers that identify the risk of malignant hyperthermia and opioid usefulness and dependency. Additionally, as an increasing number of surgeries are moving through inpatient and outpatient settings, a risk-stratification tool based on the prediction of post-operative complications plays a role in deciding the best treatment setting for individuals.

How Precision is Different

Peri-operative Care

  • A single buccal sample can cover all 3 tests: CYP2D6 metabolizer status, analgesia appropriateness, Warfarin dosing.
  • Non-invasive buccal sample is needed for peri-operative report and lifetime medication report.
  • Pharmacy consult available to anesthesiologists (optional).
  • Pharmacy consult with patient’s physician for post-operative care management (optional).
  • Post-operative Decision Support Tool (DST) for use at any time for better medication selection for the life of the patient.

Other Tests

  • Most laboratories do not run all 3 tests for surgical patients and practitioners.
  • Single buccal sample covers the both the peri-operative risk report as well as the report for future medication use by the patient.
  • Results are not accompanied by a pharmacist’s review
  • Results likely are not provided to patient’s physician for post-surgical care
  • No availability of a DST for assessing alternative, more appropriate medications

Key Goals

Getting the medications right the first time not only reduce the rising costs of healthcare but it ensures that PACU time is kept to a minimum so patients can go home in a timely manner to recover.  Hospitals will be deploying a true wellness solution designed for their surgical population

  • Identifies the fact that many people have genetic variants that negatively impact their response to surgical medications.
  • Performs risk analyses to show that the impact of getting the medications wrong can be wasted dollars on medications that are not right for that person as well as wasted time in PACU.
  • Eliminates the traditional one-size-fits-all medication method, which is not safe, nor the most effective and personalize each patient’s surgery experience.
  • Supports clinicians who are looking after the surgical patient not only in making new prescribing decisions but also toward deprescribing and rationalizing a person’s overall medication regimen.

Workflow

Sample Report

Have Questions About Us?

Our personalized approach to what we do extends beyond our genetics lab.  We, the team, are committed to providing patients, providers, and other labs the quality services and results we put our name behind.