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PREOPERATIVE EVALUATION
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Preoperative evaluation is required before all surgery. The goal of the preoperative evaluation is to assess risk of cardiovascular and other complications in the perioperative period. A thorough evaluation can help the physician and patient to weigh the risks and benefits of surgery, as well as to medically optimize a patient for surgery. The presence of comorbid conditions may necessitate additional lab, ECG, cardiac stress, PFT, or CXR testing. Nonselective imaging and lab screening tests have been shown to be of minimal value.
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KEY FACT
The indications for coronary revascularization in the preoperative patient are no different from those in patients not facing surgery. Further evaluation or treatment should not be pursued unless it would be indicated in the absence of surgery.
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Cardiac Risk Evaluation
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A preoperative cardiac risk assessment should address three major components:
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The patient's risk of a major cardiac complication (Table 12.1).
The patient's current functional status (Table 12.2).
The cardiac risk associated with the planned procedure (Table 12.3).
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Guidelines for further cardiac evaluation ...