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In Australia, there are over 2 million elective admissions into hospital each year for major non-cardiac surgery, and this number is rising. Although these operations improve symptoms and reduce premature mortality, they come with risks, of which cardiovascular complications are the most frequent, making the management of peri-operative cardiovascular risk and events a common and growing burden for health services.

Peri-operative major adverse cardiovascular events (MACE) are estimated to occur in about 3% of patients undergoing major non-cardiac surgery, and accounts for one-third of deaths at 30 days. Peri-operative MACE are regarded as those that occur within 30 days following surgery and encompass exacerbation or decompensation of existing cardiovascular disease (CVD) and first presentations of CVD, including ischaemic heart disease, stroke and transient ischaemic attack, arrhythmias, heart failure, cardiac arrest, and cardiovascular death. In addition, myocardial injury after non-cardiac surgery (MINS), defined as myocardial injury within 30 days after surgery (denoted by elevated troponin above the 99th percentile of the upper reference level for the troponin assay, with a rise/fall pattern), occurs in as many as 20% of patients and is a strong marker of future MACE.

This MJA narrative review shares more.

Learning Outcomes

1. Explain key components of the rnarrative review
2. List main findings
3. Outlines steps to accurately manage cardiovascular risk in peri-operative setting.

Details

Author: Shehane Mahendran, Aravinda Thiagalingam, Graham Hillis, Richard Halliwell, Henry CC Pleass and Clara K Chow

Article Type: Narrative review.