2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery

Fleisher, Lee A.; Fleischmann, Kirsten E.; Auerbach, Andrew D.; Barnason, Susan; Beckman, Joshua A.; Bozkurt, Biykem; Dávila‐Román, Víctor G.; Gerhard‐Herman, Marie; Holly, Thomas A.; Kane, Garvan C.; Marine, Joseph E.; Nelson, M. Timothy; Spencer, Crystal C.; Thompson, Annemarie; Ting, Henry H.; Uretsky, Barry F.; Wijeysundera, Duminda N.

doi:10.1161/cir.0000000000000106

Cited by 926 publications

(585 citation statements)

References 534 publications

(236 reference statements)

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“…16,18 Currently, the American College of Cardiology/American Heart Association Task Force have recommended that elective noncardiac surgery should be delayed by at least 30 days after bare metal stent or 365 days after drug-eluting stent implantation for coronary revascularization. 27 However, anti-platelet management during elective non-cardiac surgery remains equivocal and at the discretion of clinicians involved in the care of the patient to weigh the relative risk of bleeding with that of stent thrombosis. Lastly, 90-day mortality as opposed to the provided 30-day mortality may be a more accurate measure of the true risk of death after surgery.…”

Section: Discussionmentioning

confidence: 99%

The significance of underlying cardiac comorbidity on major adverse cardiac events after major liver resection

Tran

Worhunsky

Spain

et al. 2016

HPB

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Section: Discussionmentioning

confidence: 99%

The significance of underlying cardiac comorbidity on major adverse cardiac events after major liver resection

Tran

Worhunsky

Spain

et al. 2016

HPB

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“…2 The risk, however, varies according to the type of surgery and patient comorbidities, reaching up to 11% in high-risk patients undergoing major surgical procedures. 3 Aiming to prepare these patients and reduce perioperative complications, preoperative evaluation has become a common practice in recent years. 4 Previous studies show a great variability in the forwarding rate (10 to 40%) [5][6][7] and, despite of the presumed benefits for intermediate-to-high risks patients, the factors that determine whether an individual does or does not undergo preoperative evaluation remain unclear.…”

Section: Introductionmentioning

confidence: 99%

The impact of preoperative evaluation on perioperative events in patients undergoing cataract surgery: a cohort study

Alboim

Kliemann

Soares

et al. 2016

Eye

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Purpose Ambulatory surgery is a major area of surgical and anesthetic practice, and preoperative clinics are being increasingly used for low-risk surgical procedures. This study investigated the impact of preoperative evaluation on perioperative events in patients undergoing cataract surgery. Methods This was a retrospective cohort study of 968 consecutive patients undergoing cataract surgery. Details of medical conditions, surgical, anesthetic, and postoperative information were collected from medical records. A logistic regression model was developed using propensity score adjustment for baseline characteristics. Results Out 968 patients included, 240 (24.7%) underwent outpatient preoperative evaluation. There were no perioperative major cardiovascular events. Hypertension occurred in 319 (33%) patients, accounting for 79.7% of all adverse events. Preoperative evaluation resulted in a lower hypertension rate after adjustment for propensity score (OR = 0.6; 95% CI 0.41-0.93); no effects were observed on posterior capsule rupture and emergency visits/hospitalization within 7 days of surgery. Eighty-nine patients (9.3%) had an initial systolic pressure ≥ 180 mm Hg, which was not associated with higher risk of posterior capsule rupture (P = 0.158) or postoperative adverse events (P = 0.902). Median waiting time to surgery was 6 and 2 months for evaluated and non-evaluated patients, respectively (Po0.001). Conclusions In the context of low-risk surgery and no major perioperative and postoperative outcomes, it appears that outpatient preoperative evaluation has no role in reducing adverse events in cataract surgery candidates. Despite fewer hypertensive episodes observed in evaluated patients, these episodes were not associated with any medical or surgical outcomes.

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“…Current guidelines recommend perioperative beta‐blocker initiation before noncardiac surgery in patients with ischemic heart disease and those undergoing high‐risk surgery 1, 2. Some limitations of this study should be addressed.…”

Section: Discussionmentioning

confidence: 94%

“…However, most randomized controlled trials enrolled in that analysis included patients using beta‐blockers ≤1 day before noncardiac surgery 1. Thus, until the results of further large randomized controlled trials focusing specifically on patients with DM become available, our findings regarding the survival benefits conferred by perioperative beta‐blocker use according to initiation time in a nationwide population are of importance in this field.…”

Section: Discussionmentioning

confidence: 99%

“…The 2014 American College of Cardiology/American Heart Association guidelines recommend consideration of beta‐blocker initiation for patients with inducible ischemia on stress testing or with a Revised Cardiac Risk Index of ≥3 1. In addition, the European Society of Cardiology guidelines suggest that preoperative initiation of beta‐blockers may be considered for patients scheduled for high‐risk surgery and who have 2 clinical risk factors or American Society of Anesthesiology Physical Status Classification status of 3 2.…”

Section: Introductionmentioning

confidence: 99%

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Impact of Beta‐Blocker Initiation Timing on Mortality Risk in Patients With Diabetes Mellitus Undergoing Noncardiac Surgery: A Nationwide Population‐Based Cohort Study

Chen

Chu

Tsai

2017

JAHA

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BackgroundRelevant clinical studies have been small and have not convincingly demonstrated whether the perioperative initiation of beta‐blockers should be considered in patients with diabetes mellitus undergoing noncardiac surgery.Methods and ResultsIn this nationwide propensity score–matched study, we included patients with diabetes mellitus undergoing noncardiac surgery between 2000 and 2011 from Taiwan's National Health Insurance Research Database. Patients were classified as beta‐blocker and non–beta‐blocker cohorts. We further stratified beta‐blocker users into cardioprotective beta‐blocker (atenolol, bisoprolol, metoprolol, or carvedilol) and other beta‐blocker users. To investigate time of initiation of beta‐blocker use, initiation time was stratified into 2 periods (>30 and ≤30 days preoperatively). The outcomes of interest were in‐hospital and 30‐day mortality. After propensity score matching, we identified 50 952 beta‐blocker users and 50 952 matched controls. Compared with non–beta‐blocker users, cardioprotective beta‐blocker users were associated with lower risks of in‐hospital (odds ratio 0.75, 95% CI 0.68–0.82) and 30‐day (odds ratio 0.75, 95% CI 0.70–0.81) mortality. Among initiation times, only the use of cardioprotective beta‐blockers for >30 days was associated with decreased risk of in‐hospital (odds ratio 0.72, 95% CI 0.65–0.78) and 30‐day (odds ratio 0.72, 95% CI 0.66–0.78) mortality. Of note, use of other beta‐blockers for ≤30 days before surgery was associated with increased risk of both in‐hospital and 30‐day mortality.ConclusionsThe use of cardioprotective beta‐blockers for >30 days before surgery was associated with reduced mortality risk, whereas short‐term use of beta‐blockers was not associated with differences in mortality in patients with diabetes mellitus.

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2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery

Abstract: *Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. †ACC/AHA Representative.

Cited by 926 publications

References 534 publications

The significance of underlying cardiac comorbidity on major adverse cardiac events after major liver resection

The significance of underlying cardiac comorbidity on major adverse cardiac events after major liver resection

The impact of preoperative evaluation on perioperative events in patients undergoing cataract surgery: a cohort study

Impact of Beta‐Blocker Initiation Timing on Mortality Risk in Patients With Diabetes Mellitus Undergoing Noncardiac Surgery: A Nationwide Population‐Based Cohort Study

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