1. Home>
2. Specialties>
3. General Medicine>
4. Summary and Comment

Perioperative Evaluation of Patients Undergoing Noncardiac Surgery

A call for more attention to clinical cardiac risk factors and greater use of ß-blockers in patients undergoing noncardiac surgery

Clinicians who provide preoperative consultation should pay attention to several new reports on cardiovascular assessment and management of patients who undergo noncardiac surgery.

The American College of Cardiology and American Heart Association have updated their 1996 guidelines on perioperative cardiovascular evaluation for noncardiac surgery. The new guidelines include an annotated algorithm that stratifies patients into those who may proceed immediately to surgery and those who might benefit from noninvasive testing; the algorithm incorporates clinical risk factors, the patient's functional capacity, and type of surgery. The underlying philosophy of the guidelines is that indications for cardiac testing (e.g., exercise or pharmacologic stress testing) before surgery are similar to indications in nonoperative settings, and that coronary revascularization to "get through" noncardiac surgery is indicated only rarely.

In another report, authors present a scientific review of the role of ß-blocker therapy to prevent cardiac events after noncardiac surgery. Analysis of 5 randomized trials suggested that perioperative ß-blockade reduces cardiac morbidity. However, because the studies were rather small and included highly selected patients, questions remain about the precise target population for perioperative ß-blockade. This review article is followed by a companion "clinical applications" article, in which the authors discuss the role of perioperative ß-blockade for 3 hypothetical patients.

Comment: These articles are "must" reading for clinicians who provide preoperative consultation. Taken together, they move in the direction of greater attention to clinical risk factors, greater use of ß-blockers, and more rational use of preoperative stress testing and cardiac imaging.

— Allan S. Brett, MD

Published in Journal Watch General Medicine April 9, 2002

Citation(s):

Eagle KA et al. ACC/AHA guideline update for perioperative cardiovascular evaluation for noncardiac surgery -- Executive summary. J Am Coll Cardiol 2002 Feb 6; 39:542-53.

• Original article (Subscription may be required)
• Medline abstract (Free)

Auerbach AD and Goldman L. ß-blockers and reduction of cardiac events in noncardiac surgery: Scientific review. JAMA 2002 Mar 20; 287:1435-44.

• Original article (Subscription may be required)
• Medline abstract (Free)

Auerbach AD and Goldman L. ß-blockers and reduction of cardiac events in noncardiac surgery: Clinical applications. JAMA 2002 Mar 20; 287:1445-7.

• Original article (Subscription may be required)
• Medline abstract (Free)

2011 Year in Review