Cardiac risk in noncardiac surgery

Preoperative risk assessment plays an important role in reducing perioperative morbidity and mortality in patients undergoing noncardiac surgery. In general, evaluation should reflect the circumstances of the consultation and the nature of the surgical illness. If emergent surgery is indicated, it may not allow further cardiac assessment or treatment. Perioperative medical management, surveillance and postoperative risk stratification is appropriate in these cases and may be instrumental to improving long-term outcomes. Successful perioperative evaluation is best achieved with an integrated multidisciplinary approach and good communication between the patient, primary care physician, anesthesiologist, consultant, and surgeon. A thorough history and physical examination is the most important component of a comprehensive preoperative evaluation. In general, indications for further cardiac testing and treatments are similar to those in the nonoperative setting. Coronary revascularization before noncardiac surgery is indicated in only a small subgroup of patients at very high cardiac risk. Finally, the goal of appropriate preoperative evaluation and therapy should be to not only improve immediate periprocedural outcomes but should also be geared towards improved long term clinical outcome.