preoperative evaluation & management
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Notes
- in general, proceed to urgent or emergency surgery without additional testing or medications
- in general, obtain a personal & family medical history before elective surgery
- frailty assessment in the elderly predicts postoperative complications[39]
preoperative medication management
- see perioperative management
- also see preoperative medication management guidelines from the Mayo Clinic[34]
preoperative laboratory testing
Cardiovascular risk for non cardiac surgery (also see cardiac stress testing)
- preoperative electrocardiogram
- not indicated for asymptomatic patients ungoing low-risk surgery[11]
- indicated for asymptomatic patients with known arrhythmia or cardiovascular disease & good performance status (> 4 METS)[11]
- within 3 months adequate[37]
- cardiac stress testing NOT needed for
- low-risk surgery[11]
- endoscopic surgery
- cataract removal
- superficial surgery under local anesthetic
- breast surgery
- ambulatory surgery
- except if
- unstable angina or myocardial infarction within 30 days
- decompensated heart failure
- unstable cardiac arrhythmia
- severe valvular heart disease[11]
- age < 55 years, no cardiac murmur, no preexisting illness
- recent (6 month-1 year) normal coronary imaging & no new symptoms
- stable angina
- emergent surgical intervention indicated
- wait at least 9 months after ischemic stroke or TIA prior to elective non-cardiac surgery[18]
- low-risk surgery[11]
- preoperative cardiac stress testing reserved for patients with intermediate-risk or high-risk surgery when testing would influence management
- these are patients with low exercise tolerance & multiple major risk factors
- minimum functional capacity that obviates the need for preoperative cardiac stress testing is 4 METS (walking up a flight of stairs or a hill)
- adequate exercise tolerance is defined as >= 4 METS without symptoms[11]
- these are patients with low exercise tolerance & multiple major risk factors
- carotid ultrasound for asymptomatic carotid stenosis is not indicated
- asymptomatic carotid bruit is not predictive or perioperative stroke[11]
- carotid artery stenosis not associated with postoperative myocardial injury[20]
- combining carotid endarterectomy with cardiac surgery in patients with > 70% but asymptomatic carotid stenosis is associated with more perioperative strokes than cardiac surgery alone[21]
- major risk factors:
- congestive heart failure
- unstable angina
- myocardial infarction within 6 months
- critical aortic stenosis
- dysrhythmias, ventricular or supraventricular
- stroke within 2 weeks
- pulmonary hypertension[11]
- other risk factor requring preoperative testing
- signs/symptoms as risk factos:
- shortness of breath at rest or exertion
- chest pain or anginal equivalent
- prolonged palpitations, presyncope or syncope:
- pulmonary crackles
- increased jugular venous pressure
- gallop rhythm, irregular rhythm
- systolic murmur of aortic stenosis
- risk associated with surgical site (descending risk)
- vascular thoracic
- orthopedic
- abdominal
- otolaryngolic
- urologic, ophthalmic
- Laboratory:
- see preoperative laboratory testing
- preoperative serum NT pro-BNP predicts postoperative cardiovascular events[31]
- see preoperative laboratory testing
- Management:
- surgery without further testing for low-risk patients
- may include patients for orthopedic surgery
- if no risk factors[11]
- small area of reversible ischemia on nuclear stress testing[37]
- exertional angina after 30 minutes of walking briskly resolving with rest[37]
- may include patients for orthopedic surgery
- all usual cardiac & antihypertensive medications should be taken on the morning of surgery with a sip of water; continue statins in patients taking them[9]
- treat congestive heart failure until well compensated prior to surgery
- exception: proceed with emergency surgery without delay
- administration of loop diuretic while preparing for emergency surgery
- exception: proceed with emergency surgery without delay
- cardiac stress testing should be done only if the results of testing will affect management[11]
- estimated functional capacity as metabolic equivalents (METS) does not predict risk for MI or death at 30 days[29]
- non-invasive testing for intermediate risk patients
- echocardiogram for suspected aortic stenosis
- pharmacologic stress test prior to vascular surgery
- pharmacologic stress test prior to orthopedic surgery with risk of major adverse cardiac event > 1% (exercise stress test not an option)[11]
- exercise stress test before non-vascular surgery
- poor choice for a patient with knee osteoarthritis[11]
- preoperative electrocardiogram for asymptomatic patients with known cardiovascular disease & good performance status (> 4 METS)[11]
- MI within the last 6 months
- postpone surgery if possible
- cardiac catheterization with angioplasty may reduce cardiac risk to an acceptable level
- stroke: postpone elective surgery for at least 9 months after ischemic stroke[11][18]
- unstable angina
- postpone surgery if possible
- optimize medical management
- cardiac catheterization, PCI < 90 days prior to surgery may increase cardiac risk[11]
- moderate to severe aortic stenosis
- echocardiogram within 1 year or change in status[11]
- critical aortic stenosis
- consider valve replacement or valvuloplasty prior to elective procedure
- dysrhythmias
- consider cardioversion for atrial fibrillation
- target ventricular response for patients with chronic atrial fibrillation to undergo elective surgery is < 110/min[37]
- see direct oral anticoagulant vs warfarin or perioperative anticoagulation if patient anticoagulated
- sustained or complex dysrhythmias
- rule out electrolyte & blood gas abnormalities
- rule out MI, CHF exacerbation, PE
- rule out cardiac disease in patients with:
- perioperative beta-blocker reduces cardiac morbidity in patients with cardiovascular disease (see perioperative management)
- perioperative clonidine reduces mortality
- routine coronary angiography &/or coronary artery revascularization in patients with stable coronary artery disease NOT helpful before elective vascular surgery[5][6][9][11]
- delay elective surgery after PCI[9]
- 1-4 weeks for recipients of PCI without stents
- 4-6 weeks for recipients of PCI with bare metal stents
- >= 3-6 months recipients of PCI with drug-eluting stents[36]
- hold clopidogrel 5-7 days prior to surgery, continue low dose aspirin[36]
- hold prasugrel 7 days & ticagrelor 3-5 days prior to surgery
- witholding low-dose aspirin & clopidogrel may be reasonable if bleeding risk is extreme or consequences catastrophic, as with neurosurgery
- delay or cancel elective surgery for patients with pulmonary hypertension[11]
- refer patient for evaluation of pulmonary hypertension
- surgery without further testing for low-risk patients
Bleeding disorders
- risk factors
- inherited coagulation disorders
- acquired coagulation disorders
- quantitative platelet disorders - thrombocytopenia
- qualitative platelet disorders
- aspirin & other non-steroidal anti-inflammatory drugs
- clopidogrel (Plavix)
- renal insufficiency, uremia
- clinical manifestations:
- bleeding into soft tissues or retroperitoneum with hematoma suggests coagulation disorder
- mucosal bleeding, petechiae or purpura suggests platelet disorder
- arterial or venous thrombosis in a bleeding patient suggests DIC
- Laboratory:
- Management:
- obtain a personal & family medical history & bleeding history before elective surgery[37]
- desmopressin (DDAVP) 0.3 ug/kg over 15-30 minutes
- hemophilia A, hemophilia B, vWD, uremia
- effects lasts 6 hours
- cryoprecipitate 0.1-0.5 bags/kg preceding surgery, then 0.1-0.3 bags/kg every 12-24 hours
- factor VIII concentrate
- 30 units/kg followed by 10-20 units/kg every 12 hours
- alternative to cryoprecipitate in patients with hemophilia A
- fresh frozen plasma
- hemophilia B
- 40 mg/kg followed by 10-15 mL/kg every 12 hours
- liver disease
- 10-20 mg/kg followed by 10 mL/kg every 6-12 hours
- hemophilia B
- correct vitamin K deficiency: 10 mg vit K SC QD
- treat underlying etiology of DIC
- platelet transfusions
- platelets < 50,000-75,000/mm3
- 6-8 unit increments given
- follow platelet counts
Pulmonary disease
- complications:
- asthma
- bronchospasm
- inspissated secretions
- moderate asthma not risk factor for noncardiothoracic surgery[8]
- COPD
- obesity: NOT a risk factor for pulmonary complications[8]
- postoperative pneumonia
- asthma
- clinical manifestations:
- dyspnea, wheezing
- productive cough - best clinical predictor of post-operative complications
- barrel chest, hyperresonance, intercostal retractions, cyanosis, clubbing, active wheezing, rhonchi
- smoking
- Laboratory:
- pulmonary function tests
- indications
- lung resection
- controversial indications: age > 60. history of asthma or COPD, history of smoking, anesthesia requirement > 2 hours, upper abdominal or thoracic surgery
- not routinely indicated in patients with chronic lung disease[11] (see indications for preoperative laboratory testing)
- minimum pulmonary reserve necessary for general anesthesia
- no absolute value of FEV1 or FEV1/FVC precludes surgery[40]
- values do not help predict perioperative pulmonary complications
- indications
- arterial blood gas - as indicated
- pulmonary function tests
- Radiology
- chest X-ray
- as indicated
- not routine in patients with chronic lung disease[8][11]
- chest X-ray
- Management:
- smoking cessation 1-2 months prior to surgery reduces risk of postoperative complications[30]
- lung expansion maneuvers, incentive spirometry[30]
- preoperative inspiratory muscle training reduces risk of postoperative pneumonia & length of stay[30]
- training consists of 5-7 sessions/week for 2-3 weeks before surgery
- perioperative prophylactic respiratory physiotherapy reudces postoperative pulmonary complications (see perioperative management)[11]
- post-operative incentive spirometry of no benefit in preventing postoperative pulmonary complications[44]
- preoperative inspiratory muscle training reduces risk of postoperative pneumonia & length of stay[30]
- training in postoperative breathing exercises before upper abdominal surgery reduces postoperative pulmonary complications[28]
- COPD: aggressive postural drainage, chest physiotherapy & incentive spirometry
- continue beta-2 agonist bronchodilators pre- & post operatively
- stress doses of parenteral glucocorticoids for patients who had received parenteral steroids with the last year
- may not be required for patients receiving low-dose & short course glucocorticoids[11]
- reduce levels of theophylline in perioperative period
- toxicity of theophylline is enhanced by general anesthesia
- short course of broad-spectrum antibiotics in patients with productive cough to decrease volume of pulmonary secretions
- asthma:
- liberal pre-operative hydration for asthmatic patients
- patients taking inhaled steroids may need parenteral steroid coverage to avoid exacerbation of pulmonary disease in the perioperative period
- screening for obstructive sleep apnea (STOP-BANG)[11]
- use of nasogastric tubes is not recommended for prevention of postoperative pulmonary complications[44]
- delay or cancel elective surgery for patients with pulmonary hypertension[11]
- refer patient for evaluation of pulmonary hypertension
liver disease
- liver function testing if examination suggests liver disease
- delay elective surgery until evaluation of liver disease complete[11]
- in general, elective surgery is safe if MELD score < 8-10 & is not recommended if MELD score is > 14[11]
- a MELD score > 20 precludes elective surgery[42]
endocrine
- discontinue oral contraceptives 4 weeks prior to surgery[3]
- 2-4 fold increase risk of post-operative thrombosis
- delay surgery for severe hypothyroidism
- mild hypothyroidism is not a risk factor for postoperative complication[11]
- perioperative adrenal insufficiency
- patient-related risk factors
- primary adrenal insufficiency
- daily adrenal suppressive dose of glucocorticoid for >= 3 weeks in previous year (prednisone 10 mg QD)
- management
- if high risk surgery
- hydrocortisone 50-100 mg IV before surgery, then 25-50 mg IV every 8 hours for 24-48 hours
- if low risk surgery:
- usual dose of glucocorticoid on day of surgery
- if high risk surgery
- patient-related risk factors
- patients with untreated, asymptomatic mild hypothyroidism do not need preoperative testing or treatment[11]
renal disease
- electrolytes & serum creatinine
- BUN/creatinine ratio > 20 indicates azotemia, but does not increase risk for postoperative delirium[33]
- end-stage renal disease
- patients on renal replacement therapy should have dialysis the day prior to surgery[11]
Other considerations
- American Society of Anesthesiologists (ASA) score predicts postoperative complications
- frailty score better than ASA score in the elderly
- discontinue antiplatelet agents (aspirin & clopidogrel) unless low-risk surgery 7-10 days prior to elective surgery[7][11]
- discontinue Gingko biloba 6 days prior to elective surgery
- special considerations for warfarin (see warfarin & surgery)
- cervical spine radiography with flexion & extension views for patients with chronic or aggressive rheumatoid arthritis[11][13]
- delay of surgery for traumatic hip fracture is associated with increased mortality[11]
- screen for alcohol abuse (AUDIT-C)
- alchohol abuse before surgery increases risk of postoperative complications
- abstinence prior to surgery diminishes risk[12]
- depression (Geriatric Depression Scale score > 4) increase risk for postoperative delirium[33]
- screen for obstructive sleep apnea[11] STOP-BANG
- risk for arterial thrombosis or venous thrombosis is increased by sepsis (RR=3.3), septic shock (RR-5.7) & systemic inflammatory response syndrome (RR=2.5)[19]
- preoperative high-intensity interval training may improve cardiorespiratory fitness & reduce postoperative complications[38]
- pregnant patients should undergo same preoperative evaluation as non-pregnant patients[11]
- evaluate for Staphylococcus aurues nasal carriage & decolonize with mupirocin for 5 days with or without chlorhexidine body wash if positive[11]
More general terms
More specific terms
- preoperative chest X-ray
- preoperative laboratory testing
- simple fitness questions that predict risk of post-operative morbidity
Additional terms
- cardiac stress testing
- perioperative management
- perioperative risk assessment
- post-operative management
References
- ↑ Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 22-25
- ↑ Journal Watch 22(9):67, 2002 Eagle KA et al J Am Coll Cardiol 39:542, 2002 Aurbach AD & Goldman L, JAMA 287:1435, 2002 Aurbach AD & Goldman L, JAMA 287:1445, 2002
- ↑ 3.0 3.1 Prescriber's Letter 9(7):39 2002
- ↑ Journal Watch 24(18):143-44, 2004 Wallace AW, Galindez D, Salahieh A, Layug EL, Lazo EA, Haratonik KA, Boisvert DM, Kardatzke D. Effect of clonidine on cardiovascular morbidity and mortality after noncardiac surgery. Anesthesiology. 2004 Aug;101(2):284-93. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15277909
- ↑ 5.0 5.1 Journal Watch 25(2):13, 2005 McFalls EO, Ward HB, Moritz TE, Goldman S, Krupski WC, Littooy F, Pierpont G, Santilli S, Rapp J, Hattler B, Shunk K, Jaenicke C, Thottapurathu L, Ellis N, Reda DJ, Henderson WG. Coronary-artery revascularization before elective major vascular surgery. N Engl J Med. 2004 Dec 30;351(27):2795-804. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15625331
- ↑ 6.0 6.1 Journal Watch 25(6):47, 2005 Monahan TS, Shrikhande GV, Pomposelli FB, Skillman JJ, Campbell DR, Scovell SD, Logerfo FW, Hamdan AD. Preoperative cardiac evaluation does not improve or predict perioperative or late survival in asymptomatic diabetic patients undergoing elective infrainguinal arterial reconstruction. J Vasc Surg. 2005 Jan;41(1):38-45; discussion 45. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15696041
- ↑ 7.0 7.1 Journal Watch 25(10):80, 2005 Cahill RA, McGreal GT, Crowe BH, Ryan DA, Manning BJ, Cahill MR, Redmond HP. Duration of increased bleeding tendency after cessation of aspirin therapy. J Am Coll Surg. 2005 Apr;200(4):564-73; quiz A59-61. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15804471
- ↑ 8.0 8.1 8.2 8.3 Qaseem A, Snow V, Fitterman N, Hornbake ER, Lawrence VA, Smetana GW, Weiss K, Owens DK, Aronson M, Barry P, Casey DE Jr, Cross JT Jr, Fitterman N, Sherif KD, Weiss KB; Clinical Efficacy Assessment Subcommittee of the American College of Physicians. Risk assessment for and strategies to reduce perioperative pulmonary complications for patients undergoing noncardio- thoracic surgery: a guideline from the American College of Physicians. Ann Intern Med. 2006 Apr 18;144(8):575-80. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/16618955 <Internet> http://www.annals.org/content/144/8/575.full
Smetana GW et al, Perioperative pulmonary risk stratification for noncardithoracic surgery: Systematic review for the American College of Physicians. Ann Intern Med 2006; 144:581 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/16618956 <Internet> http://www.annals.org/content/144/8/581.full
Lawrence VA et al, Stategies to reduce postoperative pulmonary complications after noncardiothoracic surgery: Systematic review for the American College of Physicians Ann Intern Med 2006; 144:596 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/16618957 <Internet> http://www.annals.org/content/144/8/596.full - ↑ 9.0 9.1 9.2 9.3 American College of Cardiology Foundation/American Heart Association Task Force, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine, Society for Vascular Surgery, Fleisher LA, Beckman JA, Brown KA, Calkins H, Chaikof EL, Fleischmann KE, Freeman WK, Froehlich JB, Kasper EK, Kersten JR, Riegel B, Robb JF. 2009 ACCF/AHA focused update on perioperative beta blockade incorporated into the ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery. J Am Coll Cardiol 2009 Nov 24;54(22):e13-e118 PMID: https://www.ncbi.nlm.nih.gov/pubmed/19926002
Fleisher LA et al, ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for non-cardiac surgery... J Am Coll Cardiol 2007, 50:e159 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/17950140 <Internet> http://dx.doi.org/10.1016/j.jacc.2007.09.003 - ↑ Brotman DJ et al. Discontinuation of antiplatelet therapy prior to low-risk noncardiac surgery in patients with drug-eluting stents: A retrospective cohort study. J Hosp Med 2007 Nov; 2:378. PMID: https://www.ncbi.nlm.nih.gov/pubmed/18081175
- ↑ 11.00 11.01 11.02 11.03 11.04 11.05 11.06 11.07 11.08 11.09 11.10 11.11 11.12 11.13 11.14 11.15 11.16 11.17 11.18 11.19 11.20 11.21 11.22 11.23 11.24 11.25 11.26 11.27 11.28 11.29 11.30 11.31 11.32 11.33 11.34 Medical Knowledge Self Assessment Program (MKSAP) 14, 15, 16, 17, 18, 19. American College of Physicians, Philadelphia 2006, 2009, 2012, 2015, 2018, 2022.
McGlothlin DP, Granton J, Klepetko W, et al. ISHLT consensus statement: Perioperative management of patients with pulmonary hypertension and right heart failure undergoing surgery [Editorial]. J Heart Lung Transplant. 2022;41:1135-1194. PMID: https://www.ncbi.nlm.nih.gov/pubmed/36123001 - ↑ 12.0 12.1 Bradley KA et al. Alcohol screening and risk of postoperative complications in male VA patients undergoing major non-cardiac surgery. J Gen Intern Med 2011 Feb; 26:162. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20878363
Harris AHS et al. Preoperative alcohol screening scores: Association with complications in men undergoing total joint arthroplasty. J Bone Joint Surg Am 2011 Feb; 93:321 PMID: https://www.ncbi.nlm.nih.gov/pubmed/21325583 - ↑ 13.0 13.1 Grauer JN, Tingstad EM, Rand N, Christie MJ, Hilibrand AS. Predictors of paralysis in the rheumatoid cervical spine in patients undergoing total joint arthroplasty. J Bone Joint Surg Am. 2004 Jul;86-A(7):1420-4. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15252088
- ↑ Lieb K, Selim M. Preoperative evaluation of patients with neurological disease. Semin Neurol. 2008 Nov;28(5):603-10 PMID: https://www.ncbi.nlm.nih.gov/pubmed/19115168
- ↑ Patel MS, Carson JL. Anemia in the preoperative patient. Med Clin North Am. 2009 Sep;93(5):1095-104 PMID: https://www.ncbi.nlm.nih.gov/pubmed/19665622
- ↑ Chow WB, Rosenthal RA, Merkow RP et al Optimal preoperative assessment of the geriatric surgical patient: a best practices guideline from the American College of Surgeons National Surgical Quality Improvement Program and the American Geriatrics Society. J Am Coll Surg. 2012 Oct;215(4):453-66 PMID: https://www.ncbi.nlm.nih.gov/pubmed/22917646
- ↑ Fleisher LA et al 2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25091544 <Internet> http://content.onlinejacc.org/article.aspx?articleid=1893784
Kristensen SD et al 2014 ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assessment and management. The Joint Task Force on non-cardiac surgery: cardiovascular assessment and management of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA). Eur Heart J (2014). August 2014 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25086026 <Internet> http://eurheartj.oxfordjournals.org/content/early/2014/07/28/eurheartj.ehu282.extract - ↑ 18.0 18.1 18.2 Jorgensen ME et al. Time elapsed after ischemic stroke and risk of adverse cardiovascular events and mortality following elective noncardiac surgery. JAMA 2014 Jul 16; 312:269. PMID: https://www.ncbi.nlm.nih.gov/pubmed/25027142
- ↑ 19.0 19.1 Donze JD et al. Impact of sepsis on risk of postoperative arterial and venous thromboses: Large prospective cohort study. BMJ 2014 Sep 8; 349:g5334 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25199629 <Internet> http://www.bmj.com/content/349/bmj.g5334
- ↑ 20.0 20.1 Sonny A et al. Lack of association between carotid artery stenosis and stroke or myocardial injury after noncardiac surgery in high-risk patients. Anesthesiology 2014 Nov; 121:922 PMID: https://www.ncbi.nlm.nih.gov/pubmed/25216396
- ↑ 21.0 21.1 Li Y et al. Strokes after cardiac surgery and relationship to carotid stenosis. Arch Neurol 2009 Sep; 66:1091. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19752298
- ↑ Oresanya LB, Lyons WL, Finlayson E. Preoperative assessment of the older patient: a narrative review. JAMA. 2014;311:2110-2120 PMID: https://www.ncbi.nlm.nih.gov/pubmed/24867014
- ↑ Committee on Standards and Practice Parameters, Apfelbaum JL, Connis RT, Nickinovich DG; American Society of Anesthesiologists Task Force on Preanesthesia Evaluation, Pasternak LR, Arens JF, Caplan RA, Connis RT, Fleisher LA, Flowerdew R, Gold BS, Mayhew JF, Nickinovich DG, Rice LJ, Roizen MF, Twersky RS. Practice advisory for preanesthesia evaluation: an updated report by the American Society of Anesthesiologists Task Force on Preanesthesia Evaluation. Anesthesiology. 2012 Mar;116(3):522-38 PMID: https://www.ncbi.nlm.nih.gov/pubmed/22273990 (corresponding NGC guideline withdrawn Dec 2017)
- ↑ Nicholas JA. Preoperative optimization and risk assessment. Clin Geriatr Med. 2014 May;30(2):207-18. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/24721361
- ↑ Kim KI, Park KH, Koo KH, Han HS, Kim CH. Comprehensive geriatric assessment can predict postoperative morbidity and mortality in elderly patients undergoing elective surgery. Arch Gerontol Geriatr. 2013 May-Jun;56(3):507-12. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23246499
- ↑ Robinson TN, Wu DS, Sauaia A et al Slower walking speed forecasts increased postoperative morbidity and 1-year mortality across surgical specialties. Ann Surg. 2013 Oct;258(4):582-8; discussion 588-90. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23979272 Free PMC Article
- ↑ Robinson TN, Wu DS, Pointer L Simple frailty score predicts postoperative complications across surgical specialties. Am J Surg. 2013 Oct;206(4):544-50. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23880071 Free PMC Article
- ↑ 28.0 28.1 Boden I, Skinner EH, Browning L et al Preoperative physiotherapy for the prevention of respiratory complications after upper abdominal surgery: pragmatic, double blinded, multicentre randomised controlled trial. BMJ 2018;360:j5916 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29367198 <Internet> http://www.bmj.com/content/360/bmj.j5916
- ↑ 29.0 29.1 Wijeysundera DN et al. Assessment of functional capacity before major non-cardiac surgery: An international, prospective cohort study. Lancet 2018 Jun 30; 391:2631 PMID: https://www.ncbi.nlm.nih.gov/pubmed/30070222
- ↑ 30.0 30.1 30.2 30.3 Katsura M, Kuriyama A, Takeshima T et al Preoperative inspiratory muscle training for postoperative pulmonary complications in adults undergoing cardiac and major abdominal surgery. Cochrane Database Syst Rev. 2015 Oct 5;(10):CD010356. PMID: https://www.ncbi.nlm.nih.gov/pubmed/26436600
do Nascimento Junior P, Modolo NS, Andrade S et al Incentive spirometry for prevention of postoperative pulmonary complications in upper abdominal surgery. Cochrane Database Syst Rev. 2014 Feb 8;(2):CD006058 PMID: https://www.ncbi.nlm.nih.gov/pubmed/24510642 Free PMC Article - ↑ 31.0 31.1 Duceppe E, Patel A, Chan MTV et al. Preoperative N-terminal pro-B-type natriuretic peptide and cardiovascular events after noncardiac surgery: A cohort study. Ann Intern Med 2019 Dec 24 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31869834 https://annals.org/aim/article-abstract/2758032/preoperative-n-terminal-pro-b-type-natriuretic-peptide-cardiovascular-events
- ↑ Smilowitz NR, Berger JS. Perioperative cardiovascular risk assessment and management for noncardiac surgery: A review. JAMA 2020 Jul 21; 324:279. PMID: https://www.ncbi.nlm.nih.gov/pubmed/32692391 Review. https://jamanetwork.com/journals/jama/fullarticle/2768470
- ↑ 33.0 33.1 33.2 Geriatric Review Syllabus, 10th edition (GRS10) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2019
Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022 - ↑ 34.0 34.1 Pfeifer KJ et al. Preoperative management of gastrointestinal and pulmonary medications: Society for Perioperative Assessment and Quality Improvement (SPAQI) consensus statement. Mayo Clin Proc 2021 Dec; 96:3158. https://www.mayoclinicproceedings.org/article/S0025-6196(21)00633-9/fulltext
Oprea AD et al. Preoperative management of medications for psychiatric diseases: Society for Perioperative Assessment and Quality Improvement consensus statement. Mayo Clin Proc 2022 Feb; 97:397. https://www.mayoclinicproceedings.org/article/S0025-6196(21)00850-8/fulltext
Oprea AD et al. Preoperative management of medications for neurologic diseases: Society for Perioperative Assessment and Quality Improvement consensus statement. Mayo Clin Proc 2022 Feb; 97:375. https://www.mayoclinicproceedings.org/article/S0025-6196(21)00849-1/fulltext
Russell LA et al. Preoperative management of medications for rheumatologic and HIV diseases: Society for Perioperative Assessment and Quality Improvement (SPAQI) consensus statement. Mayo Clin Proc 2022 Aug; 97:1551. https://www.mayoclinicproceedings.org/article/S0025-6196(22)00261-0/fulltext - ↑ Pfeifer KJ, Selzer A, Mendez CE, et al. Preoperative management of endocrine, hormonal, and urologic medications: Society for Perioperative Assessment and Quality Improvement (SPAQI) consensus statement. Mayo Clin Proc 2021 Jun; 96:1655. PMID: https://www.ncbi.nlm.nih.gov/pubmed/33714600 Review. https://mayoclinicproceedings.org/retrieve/pii/S0025619620311290
- ↑ 36.0 36.1 36.2 Levine GN, Bates ER, Bittl JA et al 2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2016 Sep 6;68(10):1082-115 PMID: https://www.ncbi.nlm.nih.gov/pubmed/27036918 Free full text Circulation. 2016 Sep 6;134(10):e123-55. PMID: https://www.ncbi.nlm.nih.gov/pubmed/27026020 Free full text
- ↑ 37.0 37.1 37.2 37.3 37.4 37.5 NEJM Knowledge+ Hematology
- ↑ 38.0 38.1 Clifford K, Woodfield JC, Tait W et al Association of Preoperative High-Intensity Interval Training With Cardiorespiratory Fitness and Postoperative Outcomes Among Adults Undergoing Major Surgery. A Systematic Review and Meta-Analysis. JAMA Netw Open. 2023;6(6):e2320527 PMID: https://www.ncbi.nlm.nih.gov/pubmed/37389875 https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2806718
- ↑ 39.0 39.1 Alvarez-Nebreda ML, Bentov N, Urman RD, et al. Recommendations for preoperative management of frailty from the Society for Perioperative Assessment and Quality Improvement (SPAQI). J Clin Anesth. 2018;47:33-42. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29550619
- ↑ 40.0 40.1 Miskovic A, Lumb AB. Postoperative pulmonary complications. Br J Anaesth. 2017;118:317-34. PMID: https://www.ncbi.nlm.nih.gov/pubmed/28186222
- ↑ Benesch C, Glance LG, Derdeyn CP, et al; American Heart Association Stroke Council; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology; Council on Epidemiology and Prevention. Perioperative neurological evaluation and management to lower the risk of acute stroke in patients undergoing noncardiac, nonneurological surgery: a scientific statement from the American Heart Association/American Stroke Association. Circulation. 2021:CIR0000000000000968. PMID: https://www.ncbi.nlm.nih.gov/pubmed/33827230
- ↑ 42.0 42.1 Northup PG, Friedman LS, Kamath PS. AGA Clinical practice update: Surgical risk assessment and perioperative management in cirrhosis. Clin Gastroenterol Hepatol 2018 Sep 28; PMID: https://www.ncbi.nlm.nih.gov/pubmed/30273751 https://www.cghjournal.org/article/S1542-3565(18)31075-9/pdf
- ↑ Cohn SL. Preoperative evaluation for noncardiac surgery. Ann Intern Med. 2016;165:ITC81-ITC96. PMID: https://www.ncbi.nlm.nih.gov/pubmed/27919097
- ↑ 44.0 44.1 44.2 Odor PM, Bampoe S, Gilhooly D, Creagh-Brown B, Moonesinghe SR. Perioperative interventions for prevention of postoperative pulmonary complications: systematic review and meta-analysis. BMJ. 2020 Mar 11;368:m540 PMID: https://www.ncbi.nlm.nih.gov/pubmed/32161042 PMCID: PMC7190038 Free PMC article