Perioperative Optimization of the Cardiac Surgical Patient

Preoperative optimization and rapid discharge after coronary artery bypass grafting

“…Preoperative optimization of patients undergoing CABG includes, but is not limited to, smoking cessation, assessment and optimization of diabetes, depressed ventricular function and anaemia, as well as physical reconditioning, correcting malnutrition and addressing patients’ knowledge gaps, cognitive assumptions and mood (Fig. 1) [1,4,5 ▪▪ ,9]. Although most patients referred for CABG are elective, once surgical disease is identified, there is typically an urgency for surgical consultation and scheduling that can preclude preoperative optimization.…”

“…Surgical revascularization, coronary artery bypass grafting (CABG), has been shown to have a survival benefit over medical therapy in many patients and provides symptom relief thereby improving their functional capacity and quality of life [1,2]. Cardiac surgery inevitably causes varying degrees of physiologic stress, affecting multiple organ systems, and psychological strain [3,4,5 ▪▪ ]. Patients referred for CABG increasingly present with advanced age, frailty and important comorbidities, which may contribute to complications in the postoperative phase [3,5 ▪▪ ].…”

“…Cardiac surgery inevitably causes varying degrees of physiologic stress, affecting multiple organ systems, and psychological strain [3,4,5 ▪▪ ]. Patients referred for CABG increasingly present with advanced age, frailty and important comorbidities, which may contribute to complications in the postoperative phase [3,5 ▪▪ ]. Frailty, independent of chronological age, is an important risk factor not only for mortality and morbidity after CABG, but also for prolonged lengths of stay and nonhome discharge [6–8].…”

“…When perioperative complications after CABG occur, they are not only impactful to the patient, but also prolong surgical wait times and result in a significant cost burden on the healthcare system. The literature is rife with evidence-based recommendations to guide preoperative optimization of patients with comorbidities and frailty who are undergoing CABG and preoperative optimization is an important precursor to rapidly discharge patients after CABG [1,4,5 ▪▪ ,9]. Despite this, adoption of routine strategies to optimize patients prior to CABG has not been widespread…”

“…5 The presence of anaemia is an indicator of frailty and baseline anaemia increases the requirement for perioperative allogenic blood transfusion (ABT)[6]. Current guidelines widely recommend routine assessment and work up for anaemia with a view towards optimization prior to cardiac surgery[5 …”