How Would You Manage Perioperative Cardiovascular Risk for Noncardiac Surgery in This Patient With Complex Comorbidity? Grand Rounds Discussion From Beth Israel Deaconess Medical Center

Perioperative cardiovascular management involves the assessment and identification of risks in patients undergoing surgery, as well as development of a plan for mitigation of those risks during and after the procedure. It includes risk stratification, which provides guidance for preoperative testing and perioperative management in patients at high risk while avoiding overscreening in those at low risk. Specific guidance is informed by the patient's medical comorbid conditions, functional capacity, and type and urgency of planned surgery. In 2024, the American Heart Association, the American College of Cardiology, and other professional organizations published a comprehensive set of evidence-based recommendations for the evaluation and management of cardiovascular risk in adults undergoing noncardiac surgery. Its methodology included systematic literature review, multidisciplinary expert consensus, and peer review. Here, 2 experts in this field, a general internal medicine physician and a cardiologist, debate how to manage the case of an 80-year-old man with multiple cardiopulmonary conditions and other organ system comorbidities who is scheduled to undergo extensive skin cancer surgery. They discuss how to approach preoperative evaluation of such a patient with a focus on optimizing his status and monitoring for cardiac complications during and after the procedure.