Perioperative Cardiovascular Outcomes and Risk Assessment in Older Adults for Noncardiac Surgery

Older adults age >65 years are the fastest growing segment of the United States population, and many undergo non-cardiac surgery each year. Despite the high prevalence of cardiovascular disease in this population, data to guide perioperative care in older adults are limited. This review summarizes the literature on cardiovascular outcomes associated with noncardiac surgery in older adults, identifies unique clinical factors to consider in geriatric cohorts, and highlights clinical practice guidelines relevant to perioperative management of older adults.

Cardiovascular complications of noncardiac surgery are most common in older adults. Current cardiovascular risk calculators may significantly underestimate preoperative cardiovascular risk in these patients. Frailty assessments and novel risk calculators can improve risk stratification in older adults. Clinical factors, including coronary artery disease, heart failure, vascular stiffness, and aortic stenosis are key pathologies that may impact surgical outcomes. Pre-operative diagnostic cardiovascular testing may be helpful to identify cardiovascular disease in select patients, but routine testing is not generally recommended.

Older adults have worse perioperative cardiovascular outcomes than younger individuals. Providers should consider clinical factors beyond those captured in traditional risk perioperative calculators to guide clinical decision making prior to noncardiac surgery.