Cardiovascular Disease: Preoperative Testing and Evaluation for Noncardiac Surgery
As the population ages, more patients will present for surgery with multiple comorbidities. Cardiovascular and associated diseases are increasing in prevalence, with associated risks of morbidity and mortality during the perioperative period. This presents the healthcare team with unique challenges. The overarching goal of preoperative evaluation, and the goal of perioperative medicine in general, is to establish the individual's risk for surgery and to mitigate that risk. Although the overall risk of noncardiac surgery is low, 50% of the perioperative mortality that does occur is related to cardiovascular complications. The preoperative evaluation is therefore a critical step toward the reduction of perioperative morbidity and mortality and the improvement of operative outcomes. A multidisciplinary, perioperative evaluation should be performed to (1) assess perioperative risks, (2) determine the need for changes in management to mitigate risks, and (3) identify those risk factors requiring long-term management. Using a systematic approach to data collection and physical examination and through the use of appropriate cardiovascular testing, a better understanding of the functional capacity of the patient is realized. This information, coupled with knowledge of the anticipated surgery and the risks unique to the procedure, will allow members of the healthcare team to plan the best way to minimize perioperative risks and improve both short-term and long-term outcomes. Together with the patient, the team will make better value-based judgments on best practices as they move through the perioperative continuum.
