Preoperative cardiac assessment of the thoracic surgical patient.
The preoperative cardiac assessment of the thoracic patient differs very little from the assessment of any patient for noncardiac surgery, aside from a few special issues. Therefore, rather than reviewing the general issue of evaluation for noncardiac surgery, which is a topic that has been reviewed many times in the recent past, this article focuses on the purposes, methods, and limitations of risk assessment in the noncardiac surgical patient with suspected coronary artery disease (CAD), including thoracic surgical patients. Because risk assessment is imprecise and the main indications for invasive coronary procedures prior to noncardiac surgery are the same for any person for whom life-expectancy is expected to be prolonged, meticulous preoperative evaluation for CAD is not usually warranted, even for patients undergoing high-risk surgery or with multiple risk factors for CAD. To help understand this point of view and to utilize cardiology consultants appropriately, implications of basic pathophysiology as well as statistical principles are also discussed.
Teplick
R
R
Department of Anesthesia, Brigham and Women's Hospital, Boston, Massachusetts, USA.
D001499:Bayes Theorem; D006332:Cardiomegaly / Q000150:complications; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000209:etiology*; D003663:Decision Trees; D004562:Electrocardiography; D006801:Humans; D006973:Hypertension / Q000150:complications; D009203:Myocardial Infarction / Q000150:complications; D011300:Preoperative Care / Q000379:methods*; D012307:Risk Factors; D019616:Thoracic Surgical Procedures