Key result
Preoperative evaluation and medical optimization, including prophylactic beta-blockers and aspirin, can improve outcomes for high-risk patients undergoing non-cardiac surgery.
Preoperative cardiac evaluation and multidisciplinary management are essential for optimizing outcomes in high-risk patients undergoing non-cardiac surgery.
May support preoperative optimization in high-risk non-cardiac surgery; leaves open prospective validation of beta-blocker and aspirin benefits.
Perioperative cardiac complications are a common cause of death and major morbidity in patients undergoing non-cardiac surgery. Preoperative evaluation and medical optimisation can improve outcomes, although the evidence base is limited. Evidence of effectiveness is strongest for prophylactic use of β-blockers in high-risk patients and aspirin in patients with coronary artery disease. Particular challenges arise among patients with heart failure or valvular heart disease or those receiving antithrombotic therapy for coronary artery stents or atrial fibrillation. Close liaison between general practitioners, surgeons, anaesthetists and cardiologists is needed for optimising preoperative management and subsequent clinical outcomes in high-risk patients.
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Scott et al. (2013) conducted a review in Patients undergoing elective non-cardiac surgery. Preoperative cardiac evaluation and management was evaluated. Preoperative evaluation and medical optimization, including prophylactic beta-blockers and aspirin, can improve outcomes for high-risk patients undergoing non-cardiac surgery.
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