Abstract
Numerous patients with cardiovascular comorbidities undergo elective non-cardiac surgery every year. Pre-procedural optimization is important because perioperative mortality is more likely due to underlying medical conditions than surgical error or anesthesia (Fleisher and Anderson, Anesthesiology 96:1039–1041, 2002). This chapter serves as a guide for the hospitalist caring for the patient scheduled for surgery. The bottom line is that patients with low risk of complications and those with urgent surgical needs should proceed without delay; the remaining patients, those with high risk of complications and without urgent surgical needs should undergo medical optimization first. No patient can be “cleared” for surgery, but instead physicians stratify patients for risk of complications and give guidance on how to attenuate those risks.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Abbreviations
- CABG:
-
Coronary artery bypass graft
- CVA:
-
Cerebrovascular accident
- MET:
-
Metabolic equivalent
- LVEF:
-
Left ventricular ejection fraction
- LMCA:
-
Left main coronary artery
- MACE:
-
Major adverse cardiac event
- MI:
-
Myocardial infarction
- NTG:
-
Nitroglycerin
- PTCA:
-
Percutaneous transluminal coronary angioplasty
- TIA:
-
Transient ischemic attack
- VF:
-
Ventricular fibrillation
Sources
Fleisher LA, Anderson GF. Perioperative risk: how can we study the influence of provider characteristics? Anesthesiology. 2002;96:1039–41.
Lee TH, Marcantonio ER, Mangione CM, et al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation. 1999;100:1043–9.
Fleisher LA, Fleischmann KE, Auerbach AD, et al. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery. J Am Coll Cardiol. 2014;64:e77–e137.
Agarwal S, Rajamanickam A, Bajaj N, Catacutan T, Griffin B, Svensson L, Anabtawi A, Tuzcu E, Kapadia S. Impact of aortic stenosis on postoperative outcomes after noncardiac surgeries. Chest. 2012;142:88A.
Hlatky MA, Boineau RE, Higginbotham MB, Lee KL, Mark DB, Califf RM, Cobb FR, Pryor DB. A brief self-administered questionnaire to determine functional capacity (the Duke Activity Status Index). Am J Cardiol. 1989;64:651–4.
Mukherjee D, Eagle KA. Perioperative cardiac assessment for noncardiac surgery: eight steps to the best possible outcome. Circulation. 2003;107:2771–4.
Moneta GL. Coronary-artery revascularization before elective major vascular surgery. Yearbook of Vascular Surgery. 2006;2006:81–2.
Vascular Events In Noncardiac Surgery Patients Cohort Evaluation (VISION) Study Investigators, Devereaux PJ, MTV C, et al. Association between postoperative troponin levels and 30-day mortality among patients undergoing noncardiac surgery. JAMA. 2012;307:2295–304.
Eagle KA, Berger PB, Calkins H, et al. ACC/AHA guideline update for perioperative cardiovascular evaluation for noncardiac surgery—executive summary. J Am Coll Cardiol. 2002;39:542–53.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2020 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Tuttle, M.K., Kannam, J.P. (2020). Perioperative Cardiac Risk Assessment. In: Wells, B., Quintero, P., Southmayd, G. (eds) Handbook of Inpatient Cardiology. Springer, Cham. https://doi.org/10.1007/978-3-030-47868-1_28
Download citation
DOI: https://doi.org/10.1007/978-3-030-47868-1_28
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-47867-4
Online ISBN: 978-3-030-47868-1
eBook Packages: MedicineMedicine (R0)