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INTRODUCTION

Over 300 million surgical procedures are performed worldwide each year. It is estimated that over 4 million people die within 30 days of surgery making it the third greatest contributor to mortality. Cardiac complications are one of the leading causes of postoperative morbidity and mortality, accounting for more than one-third of these deaths. This chapter will review preoperative evaluation and perioperative management of the patient with ischemic heart disease undergoing noncardiac surgery.

PATIENT-RELATED RISK FACTORS

History and Physical Exam

The most important element in preoperative cardiac risk assessment is a comprehensive history encompassing all relevant components of the cardiovascular system. These include symptoms of cardiovascular disease, prior cardiac disease, evaluation and interventions, risk factors, functional status, associated comorbid diseases, and medications (Table 10-1). The physical exam is important to corroborate history or elicit/assess risk factors focusing on vital signs and cardiopulmonary exam.

TABLE 10-1Key Components in Cardiac Risk Assessment

SURGERY-RELATED RISK FACTORS

Type of Surgery

The highest risk procedures are aortic and major vascular surgery and prolonged procedures with significant blood loss or fluid shifts. Table 10-2 illustrates risks of various surgical procedures.

TABLE 10-2Estimated Risks* Associated with Various Surgical Procedures

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