operation. Surgery usually within 3 weeks.
Surgery to suit both patient and surgeon.
From , with permission.
Certain cardiovascular factors have been found to correlate with cardiac complications after non-cardiac surgery. They constitute a useful risk index (Table 2.6).
The mortality following a perioperative myocardial infarction is between 40% and 60%. The risk of developing a perioperative myocardial infarction is exponentially related to the interval between a previous myocardial infarction , if there was one, and surgery (Table 2.7). It is therefore advisable to delay non-urgent surgery until at least 3 and preferably 6 months after a myocardial infarction. Patients who require surgery sooner should be considered individually and managed appropriately.
In men with coronary artery disease or who are at high risk of it, that is:
• current smoking;
• sedentary lifestyle;
Early postoperative myocardial ischaemia can occur in up to 40%, with up to a 2.8-fold increase in the odds of an adverse cardiac outcome . Clearly, these patients require special management.
Certain factors are associated with a particularly high mortality in the perioperative period, often related to the development of multiple organ failure :
• previous severe cardiorespiratory illness (acute myocar-dial infraction, stroke, chronic obstructive airway disease (COAD));
• extensive ablative surgery planned for carcinoma (oesophagectomy, gastrectomy, cystectomy);
• severe multiple trauma (>3 organs or >2 systems);
• age >70 years with evidence of limited physiologic reserve in one or more vital organs;
• septicaemia (positive blood cultures or septic focus);
• respiratory failure (PaO2 < 8kPa (60mmHg), on an FiO2 > 0.4, or mechanical ventilation >48h);
• acute abdominal catastrophe with haemodynamic instability (pancreatitis, peritonitis, perforation, gastrointestinal haemorrhage);
• acute renal failure (urea >20 mmol/l, creatinine >250 mmol/l);
• late stage vascular disease involving the aorta.
These patients probably benefit from special anaesthetic and intensive care management, which is beyond the scope of this book.
Was this article helpful?