title: Updates in perioperative medicine.
abstract: BACKGROUND
  As our surgical population becomes older and more medically complex, knowledge of the most recent perioperative literature is necessary to optimize perioperative care. We aim to summarize and critique literature published over the past year with the highest potential to impact the clinical practice of perioperative medicine.
  
  
  METHODS
  We reviewed articles published between January 2014 and April 2015, identified via MEDLINE search. The final 10 articles selected were determined by consensus among all authors, with criteria for inclusion including scientific rigor and relevance to perioperative medicine practice.
  
  
  RESULTS
  Key findings include: long term β-blockade should be continued prior to surgery, routine screening with postoperative troponin is not recommended, initiation/continuation of aspirin or clonidine in the perioperative period is not beneficial and may increase adverse outcomes, preoperative diagnosis and treatment of obstructive sleep apnea may reduce risk of postoperative cardiovascular complications, new pulmonary risk indices are available that accurately estimate postoperative pulmonary complications, postoperative atrial fibrillation is associated with increased long-term stroke risk, risk scores such as the CHADS2 (Congestive heart failure, Hypertension, Age ≥75 years, Diabetes Mellitus, previous stroke or transient ischemic attack) are superior to the Revised Cardiac Risk Index in predicting adverse postoperative outcomes for patients with nonvalvular atrial fibrillation, and utilization of bridging anticoagulation comes with a much higher risk of bleeding compared to patients who are not bridged.
  
  
  CONCLUSIONS
  The body of literature reviewed provides important information for clinicians caring for surgical patients across multiple fronts, including preoperative risk assessment, medication management, and postoperative medical care.
authors.affiliation: Department of Medicine, Rush Medical College, Chicago, Illinois.
authors.forename: Suparna
authors.initials: S
authors.lastname: Dutta
authors.affiliation: University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Steven L
authors.initials: SL
authors.lastname: Cohn
authors.affiliation: Froedtert Memorial Lutheran Hospital Clinical Cancer Center and Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Kurt J
authors.initials: KJ
authors.lastname: Pfeifer
authors.affiliation: Froedtert Memorial Lutheran Hospital Clinical Cancer Center and Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Slawski
authors.affiliation: Division of General Medicine and Primary Care, Harvard Medical School, Boston, Massachusetts.
authors.forename: Gerald W
authors.initials: GW
authors.lastname: Smetana
authors.affiliation: Department of Medicine, Rush Medical College, Chicago, Illinois.
authors.forename: Amir K
authors.initials: AK
authors.lastname: Jaffer
mesh_terms: D006801:Humans; D019990:Perioperative Care / Q000379:methods* / Q000592:standards / Q000639:trends; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D018570:Risk Assessment; D013514:Surgical Procedures, Operative / Q000379:methods