Abstract
More than 50 million surgical procedures are carried out every year in the United
States with the estimated risk of major adverse cardiac events perioperatively between
1.4 and 3.9%. Given that the majority of surgeries are elective, this allows ample
opportunity to identify patients at higher risk of perioperative adverse events and
optimize them for surgery. Preexisting cardiopulmonary disease is a major risk factor
for adverse events perioperatively and can lead to significant morbidity and mortality.
It can predispose patients to perioperative myocardial ischemia and infarction, perioperative
pulmonary complications, and perioperative stroke among other complications. This
article details an approach to preoperative interview and examination, indications
for preoperative testing, and strategies for optimization in patients with underlying
cardiopulmonary disease. It also includes guidelines on optimal timing of elective
surgery in certain clinical scenarios that can escalate perioperative risk. Through
the use of thorough preoperative assessment, targeted preoperative testing, and multidisciplinary
optimization of preexisting disease, perioperative risk can be decreased significantly
and perioperative outcomes improved.
Keywords
preoperative evaluation - cardiopulmonary disease - preoperative risk assessment -
preoperative optimization
