Perioperative management of the patient with cardiac disease

Area of Science:

• Cardiology
• Orthopaedic Surgery
• Anesthesiology

Background:

• Perioperative death incidence is low, but coronary artery disease increases cardiac complication risk.
• Orthopaedic surgery patients with known cardiac disease require careful perioperative management.
• Emergent orthopaedic procedures pose a higher risk of perioperative cardiac events compared to elective ones.

Purpose of the Study:

• To review current recommendations for preoperative cardiac testing in orthopaedic patients.
• To outline perioperative management strategies for orthopaedic patients with known cardiac disease.
• To reduce postoperative mortality and morbidity in at-risk surgical populations.

Main Methods:

• Review of current clinical guidelines and evidence-based practices.
• Analysis of risk factors for perioperative cardiac events in orthopaedic surgery.
• Discussion of pharmacological interventions (beta blockers, statins, alpha-2 agonists) for cardiac protection.

Main Results:

• Preoperative cardiac testing is indicated for select orthopaedic patients to identify and mitigate risks.
• Continuation or initiation of specific medications (beta blockers, statins, alpha-2 agonists) postoperatively can improve cardiac outcomes.
• Risk stratification is crucial for tailoring management strategies.

Conclusions:

• Judicious preoperative cardiac evaluation is essential for orthopaedic patients.
• Optimized perioperative management, including targeted medical therapies, is key to improving outcomes.
• Reducing perioperative cardiac complications is achievable through evidence-based testing and management.