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Perioperative risk of patients undergoing noncardiac surgery after coronary artery bypass surgery
Jad Daye1, Dustin Boatman, Calvin Peters
1University of Texas Southwestern Medical School, Dallas, TX, USA.
Insights
Major noncardiac surgery after coronary artery bypass surgery is common and has a very low risk of cardiac complications. Preoperative cardiac evaluation may not be necessary for most patients undergoing these procedures.
Area of Science:
- Cardiology
- Cardiac Surgery
- General Surgery
Background:
- Limited data exist on the risks of noncardiac surgery shortly after coronary artery bypass surgery (CAB) in contemporary, nonselected patient populations.
- Existing evidence primarily stems from post hoc analyses of randomized controlled trials.
Purpose of the Study:
- To evaluate the outcomes and complication rates of major noncardiac surgery performed after coronary artery bypass surgery.
- To assess the necessity of preoperative cardiac evaluation for patients undergoing noncardiac surgery post-CAB.
Main Methods:
- Retrospective review of medical records for patients who underwent coronary artery bypass surgery between January 1999 and October 2006.
- Identification of patients who subsequently underwent major noncardiac surgery and analysis of their surgical outcomes.
Main Results:
- Of 1065 patients who had CAB, 272 (26%) underwent 467 major noncardiac surgeries with a mean interval of 1.9 years post-CAB.
- A low rate of major complications (0.6%) was observed, including two deaths and one perioperative arrhythmia.
- The study identified a very low risk of cardiac complications associated with noncardiac surgery following CAB.
Conclusions:
- Noncardiac surgery is frequently required after coronary artery bypass surgery.
- The risk of cardiac complications is very low, suggesting routine preoperative cardiac evaluation may not be necessary for most patients.
- These findings support a less stringent approach to preoperative cardiac assessment in select patients following CAB.
Background:
Most data suggesting that noncardiac surgery early after coronary artery bypass surgery carries low risk are derived from post hoc analyses of randomized controlled trials, with only limited data derived from contemporary, nonselected, and nontrial patients.
Methods:
We retrospectively reviewed the medical records of patients who underwent coronary artery bypass surgery at our institution between January 1999 and October 2006 to determine whether they subsequently had major noncardiac surgery and what the outcomes of the noncardiac surgery were.
Results:
During the study period, 1065 patients underwent coronary artery bypass surgery, and 272 (26%) subsequently underwent 467 major noncardiac surgeries. The mean interval from coronary artery bypass to noncardiac surgery was 1.9 +/- 1.9 years (range, 0-7.8 years). A major complication occurred in 3 surgeries (0.6% [95% confidence interval, 0.1%-1.9%]). Two patients died (both from respiratory arrest during the postoperative period: 1 patient had a tongue cancer excision, and the other patient had polycythemia vera), and the third patient had a perioperative arrhythmia.
Conclusions:
Noncardiac surgery is often required early after coronary artery bypass surgery and carries very low risk for cardiac complications, suggesting that preoperative cardiac evaluation may not be required in most such patients.
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