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Management of Patients with Ischemic Heart Disease in Spine Surgery
Myung-Geun Song1, Chang-Won Kim2, Sang-Youn Song2
1Department of Orthopaedic Surgery, Inha University Hospital, Incheon, Korea.
Insights
Patients with ischemic heart disease (IHD) undergoing spinal surgery face increased cardiac risks. Preoperative evaluation and management are crucial for preventing perioperative cardiac complications and ensuring successful patient outcomes.
Area of Science:
- Cardiology
- Neurosurgery
- Geriatrics
Background:
- Ischemic heart disease (IHD) remains a significant risk factor for cardiac complications after noncardiac surgery, despite decreasing mortality rates.
- The aging population is driving an increase in spinal surgeries, consequently raising the number of patients with IHD or high cardiac risk undergoing these procedures.
- Perioperative cardiac complications following spinal surgery are linked to delayed recovery and increased mortality.
Purpose of the Study:
- To emphasize the importance of spinal surgeons' knowledge in managing patients with IHD or high cardiac risk undergoing spinal surgery.
- To highlight the necessity of comprehensive preoperative evaluation and management for preventing perioperative cardiac complications.
- To guide spinal surgeons on patient assessment, including functional status evaluation using metabolic equivalent of task (MET).
Main Methods:
- Review of existing literature on ischemic heart disease, spinal surgery, and perioperative cardiac risk.
- Emphasis on preoperative assessment of underlying medical conditions, including history of myocardial infarction and functional status (MET).
- Discussion on medication management, particularly anticoagulant dosage, tailored to surgical type.
Main Results:
- Patients unable to perform four METs require more extensive preoperative cardiac evaluation due to high risk of postoperative complications.
- Appropriate preoperative management and postoperative evaluation are essential for patients with a history of IHD.
- Spinal surgeons must possess comprehensive knowledge of patient care before and after surgery.
Conclusions:
- Spinal surgeons play a critical role in the perioperative management of patients with IHD or high cardiac risk.
- Thorough preoperative assessment, including functional capacity evaluation, is vital for mitigating cardiac risks.
- Optimized patient management strategies are necessary for successful surgical outcomes and improved patient recovery.
Abstract:
In ischemic heart disease (IHD), the myocardium does not receive enough blood and oxygen. Although the IHD-related mortality rate is decreasing, the risk remains and is a major predictor of cardiac complications following noncardiac surgery. Given the increase in the older population, the number of patients with spinal diseases requiring surgery is increasing. Among these patients, those with underlying IHD or a high risk of cardiac complications before and after surgery are also increasing. Given that cardiac complications following spinal surgery are associated with delayed patient recovery and even death, spinal surgeons should be knowledgeable about overall patient management, including medication therapy in those at high risk of developing perioperative cardiac complications for successful patient care. Before surgery, the underlying medical conditions of patients should be evaluated. Patients with a history of myocardial infarction should be checked for a history of surgical treatments, and the anticoagulant dose should be controlled depending on the surgery type. In addition, the functional status of patients must be examined before surgery. Functional status can be assessed according to the metabolic equivalent of task (MET). More preoperative cardiac examinations are needed for patients who are unable to perform four METs in daily because of the high risk of postoperative cardiac complications. Patients with a history of IHD require appropriate preoperative management and further postoperative evaluation. When considering surgery, spinal surgeons should be knowledgeable about patient care before and after surgery.
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