Why the study?
How should pre-operative cardiac evaluation be conducted for cardiac patients undergoing non-cardiac surgery?
How should pre-operative cardiac evaluation be conducted for cardiac patients undergoing non-cardiac surgery?
Pre-operative cardiac testing before non-cardiac surgery should be guided by clinical risk, exercise tolerance, and procedure type, and only performed if it will alter management.
Supports selective preoperative testing only if it alters management; leaves open prospective validation in contemporary cohorts.
Several recent guidelines have been published to codify the pre-operative evaluation of the cardiac patient undergoing non-cardiac surgery. Considering the lack of any randomized clinical trials in this area, they have incorporated information from both prospective cohort studies and the experience from the general care of the cardiac patient. The decision to perform testing is based on the clinical risk factors, exercise tolerance and surgical procedure. Testing should not be performed unless the results will actually change practice. Among the interventions advocated to reduce peri-operative risk, the decision to perform coronary revascularization before non-cardiac surgery must include issues related to local rates of morbidity and mortality for each of the procedures and potential long-term benefits.
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Lee A. Fleisher (1998) studied this question.
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