Head to Toe: A Perioperative Surgical Home Approach to Sepsis and Airway Obstruction in a Geriatric Patient

The perioperative surgical home (PSH) is a care delivery model designed to improve the perioperative and long-term outcomes of patients undergoing surgery by promoting holistic care and seamless cooperation between different services and subspecialties. An aging population and increased surgical complexity have led to renewed interest in PSH models. An 86-year-old female with diabetes and critical limb ischemia presented with sepsis due to right calcaneal gangrene. A structured, comprehensive evaluation by the inpatient PSH service identified perioperative concerns including malnutrition and elevated cardiac risk and led to the discovery of an airway-compromising mass. A coordinated care plan, devised by the PSH team resulted in a joint operation by otolaryngology and orthopedic surgery departments, thus avoiding what would have been an otherwise unexpected difficult airway, and likely complications. Our case highlights the explicit and implicit benefits of interdisciplinary care coordinated by an inpatient PSH service, which includes risk stratification, comprehensive evaluation, and prevention of complications.