NEW TRENDS IN PRE-OPERATIVE ASSESSMENT OF CARDIAC PATIENTS IN NON-CARDIAC SURGERY

Abstract

Each year, an increasing number of elderly patients with cardiovascular disease undergoing non-cardiac surgery require careful perioperative management to minimize the perioperative risk. Perioperative cardiovascular complications are the strongest predictors of morbidity and mortality after major non-cardiac surgery. The European and USA guidelines for cardiac risk assessment provide a framework for determining a patient’s risk and prognosis. Clinical and surgical risk and functional capacity are assessed to determine which patients will benefit from further testing and modification of perioperative management. If the surgery is not an emergency, there is the opportunity to consider postponing or cancelling surgery in high risk patients or converting to lower risk procedures such as laparoscopic or less extensive surgery. In contrast, emergency surgery should not be delayed but should be undertaken with appropriate perioperative surveillance and management. Cardiac risk assessment can also identify patients who require long-term cardiovascular risk management.