Optimizing patients with substance use disorder for cardiac surgery

Background Prehabilitation, incorporating personalized physical, nutritional, and psychological interventions before cardiac surgery, has gained recognition for enhancing patient resilience and improving surgical outcomes, particularly for high-risk populations. Among these populations, patients with substance use disorders (SUDs), including alcohol, tobacco, and other substance misuse, present unique challenges for anaesthetic management. Objectives This review aims to highlight the most recent evidence on preoperative preparation strategies focused on minimizing perioperative risks in patients with SUDs undergoing cardiac surgery. The goal is to understand how tailored approaches to preoperative care can improve outcomes in this vulnerable group. The review emphasizes the importance of thorough history-taking, comprehensive clinical evaluation, and optimized perioperative management specific to patients with SUDs. Collaboration among anesthetists, cardiologists, surgeons, and other healthcare professionals is essential to providing holistic care. Active patient engagement in preoperative optimization is highlighted as a crucial factor in improving surgical outcomes. Specialized preoperative strategies, including the management of substance withdrawal, optimization of cardiovascular function, and enhancement of psychological well-being, are essential for improving surgical outcomes in patients with SUDs. Effective collaboration with multidisciplinary teams ensures a comprehensive, patient-centered approach. Evidence suggests that preoperative optimization, alongside tailored anesthetic techniques, plays a critical role in minimizing perioperative risks and improving recovery. Conclusion Prehabilitation strategies, when adapted for patients with SUDs, offer significant benefits in minimizing perioperative complications and enhancing recovery in cardiac surgery. The success of these strategies depends on a comprehensive, multidisciplinary approach, with active patient participation in preoperative optimization. Continued research and standardized protocols are needed to further refine these strategies for this high-risk population.