title: Patients with aortic stenosis: who should undergo noncardiac surgery in a rural hospital?
abstract: OBJECTIVE
  Sometimes, patients in rural settings with aortic stenosis not severe enough to require valve replacement desire to undergo elective noncardiac procedures at their small local hospital. This has important implications for all stakeholders, including perianesthesia nurses. The purpose of this evidence-based article was to determine when it is appropriate for patients with aortic stenosis to undergo noncardiac surgery in this setting.
  
  
  METHODS
  A systematic search strategy was applied.
  
  
  RESULTS
  The search revealed 12 evidence sources meeting the inclusion criteria: one clinical practice guideline, one cohort study, two nonrandomized control trials, four case-control studies, and four narrative reviews.
  
  
  CONCLUSIONS
  The evidence suggests that patients with aortic stenosis undergoing moderate and higher risk noncardiac surgical procedures require expertise and resources often unavailable in small rural hospitals. These patients should be appropriately evaluated before the procedure. It may be appropriate for these patients to undergo low risk noncardiac surgery in small rural hospitals if stable, and there is a low likelihood of fluid shifts and unstable hemodynamics.
authors.forename: H Ruth
authors.initials: HR
authors.lastname: Fletcher
authors.forename: Lisa H
authors.initials: LH
authors.lastname: Milhoan
authors.forename: Kirk
authors.initials: K
authors.lastname: Evans
authors.forename: Paul N
authors.initials: PN
authors.lastname: Austin
mesh_terms: D001024:Aortic Valve Stenosis / Q000601:surgery*; D019317:Evidence-Based Medicine; D006780:Hospitals, Rural / Q000458:organization & administration*; D006801:Humans; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data*; D014481:United States
keywords: aortic stenosis; evidence-based practice; noncardiac surgery; rural health care; valvular disease