Identification and management of perioperative cardiovascular risk

Approximately 25 000 patients die each year in the UK following 1.3 million surgical procedures (Pearse et al, 2006). More than 80% of these perioperative deaths occur in patients who are at significantly high risk for surgery (12.5%) (Pearse et al, 2006). This population tends to be older, have multiple co-morbidities and have undergone major surgery. Notably, 50% were never admitted to a general intensive care unit postoperatively (Campling et al, 1993). Approximately 75% of patients who suffer perioperative death have cardiovascular disease, so it is important to try and identify these patients preoperatively (Mangano, 1990; National Confidential Enquiry into Perioperative Deaths, 2002).