Perioperative Cardiovascular Risk Assessment and Management for Noncardiac Surgery: A Review

JAMA : the Journal of the American Medical Association
Nathaniel R Smilowitz, Jeffrey S Berger

Abstract

Perioperative cardiovascular complications occur in 3% of hospitalizations for noncardiac surgery in the US. This review summarizes evidence regarding cardiovascular risk assessment prior to noncardiac surgery. Preoperative cardiovascular risk assessment requires a focused history and physical examination to identify signs and symptoms of ischemic heart disease, heart failure, and severe valvular disease. Risk calculators, such as the Revised Cardiac Risk Index, identify individuals with low risk (<1%) and higher risk (≥1%) for perioperative major adverse cardiovascular events during the surgical hospital admission or within 30 days of surgery. Cardiovascular testing is rarely indicated in patients at low risk for major adverse cardiovascular events. Stress testing may be considered in patients at higher risk (determined by the inability to climb ≥2 flights of stairs, which is <4 metabolic equivalent tasks) if the results from the testing would change the perioperative medical, anesthesia, or surgical approaches. Routine coronary revascularization does not reduce perioperative risk and should not be performed without specific indications independent of planned surgery. Routine perioperative use of low-dose aspirin (100 mg/d) do...Continue Reading

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Citations

Nov 25, 2020·JAMA : the Journal of the American Medical Association·Christian Grasshoff, Harry Magunia
Nov 25, 2020·JAMA : the Journal of the American Medical Association·Nathaniel R Smilowitz, Jeffrey S Berger
Dec 12, 2020·Colorectal Disease : the Official Journal of the Association of Coloproctology of Great Britain and Ireland·Arvid PourlotfiShahin Mohseni
Jan 13, 2021·JAMA : the Journal of the American Medical Association·Shi-Min HuHai-Feng Li
Mar 13, 2021·The American Journal of Cardiology·Charles V Pollack, Tracy Y Wang
Jun 28, 2021·Journal of the American Geriatrics Society·Darcy BancoNathaniel R Smilowitz
Jul 3, 2021·Journal of Community Hospital Internal Medicine Perspectives·Sharon Desales BaoasMichael Zenilman
Jul 20, 2021·Journal of Vascular Surgery Cases and Innovative Techniques·Muzafar MamatkulovAnastasia Voronova
Aug 26, 2021·Journal of Plastic Surgery and Hand Surgery·Barkat AliRohini G McKee
Oct 16, 2021·Internal and Emergency Medicine·Andrew Tiger ChenJames Demetrios Douketis

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