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Preoperative Evaluation for Major Noncardiac Surgery
Focusing on Heart Failure
Adrian F. Hernandez, MD;
L. Kristin Newby, MD, MHS;
Christopher M. O'Connor, MD
Arch Intern Med. 2004;164:1729-1736.
The number of patients undergoing major noncardiac surgery has steadily increased over the last decade. Cardiovascular complications are important and often feared by patients, surgeons, and anesthesiologists. Although preoperative risk assessment has improved since Goldman and colleagues published their landmark article that introduced the Multifactorial Index of Cardiac Risk 25 years ago, it continues to require modification, especially with the increasing prevalence of heart failure and the increase in procedures performed in the elderly. This review will summarize preoperative assessment and perioperative management with an emphasis on heart failure.
From the Divisions of Cardiology (Drs Hernandez, Newby, and O'Connor) and Clinical Pharmacology (Dr O'Connor), Department of Medicine, Duke University Medical Center and Duke Clinical Research Institute, Durham, NC. Dr Newby has received research grant support from Roche Diagnostics Corporation and Dade-Behring Inc, participates in a speaker's bureau sponsored by Biosite, and serves as a consultant for Ortho Clinical Diagnostics.
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