Skip Navigation Links.
Collapse <span class="m110 colortj mt20 fontw700">Volume 12 (2024)</span>Volume 12 (2024)
Collapse <span class="m110 colortj mt20 fontw700">Volume 11 (2023)</span>Volume 11 (2023)
Collapse <span class="m110 colortj mt20 fontw700">Volume 10 (2022)</span>Volume 10 (2022)
Collapse <span class="m110 colortj mt20 fontw700">Volume 9 (2021)</span>Volume 9 (2021)
Collapse <span class="m110 colortj mt20 fontw700">Volume 8 (2020)</span>Volume 8 (2020)
Collapse <span class="m110 colortj mt20 fontw700">Volume 7 (2019)</span>Volume 7 (2019)
Collapse <span class="m110 colortj mt20 fontw700">Volume 6 (2018)</span>Volume 6 (2018)
Collapse <span class="m110 colortj mt20 fontw700">Volume 5 (2017)</span>Volume 5 (2017)
Collapse <span class="m110 colortj mt20 fontw700">Volume 4 (2016)</span>Volume 4 (2016)
Collapse <span class="m110 colortj mt20 fontw700">Volume 3 (2015)</span>Volume 3 (2015)
Collapse <span class="m110 colortj mt20 fontw700">Volume 2 (2014)</span>Volume 2 (2014)
Collapse <span class="m110 colortj mt20 fontw700">Volume 1 (2013)</span>Volume 1 (2013)
American Journal of Medical Case Reports. 2020, 8(10), 374-382
DOI: 10.12691/AJMCR-8-10-15
Case Study

Perioperative Assessment of High-Risk Abdominal Surgery: A Case Study

Tobin Mathew1, Francesca Macaluso1 and Isabel M. McFarlane1,

1Department of Medicine, State University of New York at Downstate Health Sciences University, Brooklyn NY 11203, United States

Pub. Date: July 14, 2020
Full Text PDF

Cite this paper

Tobin Mathew, Francesca Macaluso and Isabel M. McFarlane. Perioperative Assessment of High-Risk Abdominal Surgery: A Case Study. American Journal of Medical Case Reports. 2020; 8(10):374-382. doi: 10.12691/AJMCR-8-10-15

Abstract

Objectives: Ÿ To outline the key components of a pre-operative cardiac risk assessment. Ÿ To review the major guidelines utilized to assess patients¡¯ surgical risks. Ÿ To discuss the perioperative management of surgical patients to prevent cardiac and pulmonary complications. Ÿ To review the utility of biomarkers in the pre- and post-operative period.

Keywords

perioperative evaluation, non-cardiac surgery, surgical risk calculator, revised cardiac risk, medication management, red flags, functional capacity, pulmonary risk assessment, post-operative pulmonary complications

Copyright

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References

[1]  Desborough, J.P., The stress response to trauma and surgery. BJA: British Journal of Anaesthesia, 2000. 85(1): p. 109-117.
 
[2]  Gottschalk, A., et al., Is anesthesia dangerous? Deutsches Arzteblatt international, 2011. 108(27): p. 469-474.
 
[3]  Bierle, D.M., et al., Preoperative Evaluation Before Noncardiac Surgery. Mayo Clinic Proceedings, 2020. 95(4): p. 807-822.
 
[4]  Pannell, L.M., E.M. Reyes, and S.R. Underwood, Cardiac risk assessment before non-cardiac surgery. Eur Heart J Cardiovasc Imaging, 2013. 14(4): p. 316-22.
 
[5]  Smilowitz, N.R., et al., Perioperative Major Adverse Cardiovascular and Cerebrovascular Events Associated With Noncardiac Surgery. JAMA Cardiology, 2017. 2(2): p. 181-187.
 
[6]  Cohn, S.L., Preoperative Evaluation for Noncardiac Surgery. Ann Intern Med, 2016. 165(11): p. Itc81-itc96.
 
[7]  Fleisher, L.A., et al., 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation, 2014. 130(24): p. 2215-45.
 
[8]  McPhee, J.T., et al., Perioperative mortality for pancreatectomy: a national perspective. Annals of surgery, 2007. 246(2): p. 246-253.
 
[9]  Risk Assessment for and Strategies To Reduce Perioperative Pulmonary Complications for Patients Undergoing Noncardiothoracic Surgery: A Guideline from the American College of Physicians. Annals of Internal Medicine, 2006. 144(8): p. 575-580.
 
[10]  Turrentine, F.E., et al., Surgical Risk Factors, Morbidity, and Mortality in Elderly Patients. Journal of the American College of Surgeons, 2006. 203(6): p. 865-877.
 
[11]  Kim, J.Y.S., et al., Surgical Duration and Risk of Venous Thromboembolism. JAMA Surgery, 2015. 150(2): p. 110-117.
 
[12]  Saklad, M.M.D., GRADING OF PATIENTS FOR SURGICAL PROCEDURES. Anesthesiology: The Journal of the American Society of Anesthesiologists, 1941. 2(3): p. 281-284.
 
[13]  Daabiss, M., American Society of Anaesthesiologists physical status classification. Indian journal of anaesthesia, 2011. 55(2): p. 111-115.
 
[14]  Kang, H.W., et al., Impact of the ASA Physical Status Score on Adjuvant Chemotherapy Eligibility and Survival of Upper Tract Urothelial Carcinoma Patients: a Multicenter Study. J Korean Med Sci, 2017. 32(2): p. 335-342.
 
[15]  Abouleish, A.E., M.L. Leib, and N.H. Cohen, ASA Provides Examples to Each ASA Physical Status Class. ASA Newsletter, 2015. 79(6): p. 38-49.
 
[16]  Wijeysundera, D.N., et al., Measurement of Exercise Tolerance before Surgery (METS) study: a protocol for an international multicentre prospective cohort study of cardiopulmonary exercise testing prior to major non-cardiac surgery. BMJ Open, 2016. 6(3): p. e010359.
 
[17]  Hlatky, M.A., et al., A brief self-administered questionnaire to determine functional capacity (the Duke Activity Status Index). Am J Cardiol, 1989. 64(10): p. 651-4.
 
[18]  Carter, R., et al., Criterion validity of the Duke Activity Status Index for assessing functional capacity in patients with chronic obstructive pulmonary disease. J Cardiopulm Rehabil, 2002. 22(4): p. 298-308.
 
[19]  DeMaria, E.J., et al., Validation of the obesity surgery mortality risk score in a multicenter study proves it stratifies mortality risk in patients undergoing gastric bypass for morbid obesity. Ann Surg, 2007. 246(4): p. 578-82; discussion 583-4.
 
[20]  Santo, M.A., et al., Preoperative weight loss in super-obese patients: study of the rate of weight loss and its effects on surgical morbidity. Clinics (Sao Paulo, Brazil), 2014. 69(12): p. 828-834.
 
[21]  Mills, E., et al., Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med, 2011. 124(2): p. 144-154.e8.
 
[22]  King, M.S., Preoperative evaluation. Am Fam Physician, 2000. 62(2): p. 387-96.
 
[23]  Gupta Prateek, K., et al., Development and Validation of a Risk Calculator for Prediction of Cardiac Risk After Surgery. Circulation, 2011. 124(4): p. 381-387.
 
[24]  Devereaux, P.J., et al., Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomised controlled trial. Lancet, 2008. 371(9627): p. 1839-47.
 
[25]  Rodseth, R.N., et al., The prognostic value of pre-operative and post-operative B-type natriuretic peptides in patients undergoing noncardiac surgery: B-type natriuretic peptide and N-terminal fragment of pro-B-type natriuretic peptide: a systematic review and individual patient data meta-analysis. J Am Coll Cardiol, 2014. 63(2): p. 170-80.
 
[26]  Koutsaki, M., et al., Evaluation, risk stratification and management of hypertensive patients in the perioperative period. Eur J Intern Med, 2019. 69: p. 1-7.
 
[27]  Marks, J.B., Perioperative management of diabetes. Am Fam Physician, 2003. 67(1): p. 93-100.
 
[28]  Meneghini, L.F., Perioperative management of diabetes: translating evidence into practice. Cleve Clin J Med, 2009. 76 Suppl 4: p. S53-9.
 
[29]  Saber, W., Perioperative medication management: a case-based review of general principles. Cleve Clin J Med, 2006. 73 Suppl 1: p. S82-7.
 
[30]  What Medications Should Patients Take Before Surgery? ; Available from: https://www.uclahealth.org/anes/what-medications-should-patients-take-before-surgery.
 
[31]  Naylor, A.R., Medical treatment strategies to reduce perioperative morbidity and mortality after carotid surgery. Seminars in Vascular Surgery, 2017. 30(1): p. 17-24.
 
[32]  Landoni, G., et al., Randomized Evidence for Reduction of Perioperative Mortality: An Updated Consensus Process. J Cardiothorac Vasc Anesth, 2017. 31(2): p. 719-730.
 
[33]  McFalls, E.O., et al., Coronary-Artery Revascularization before Elective Major Vascular Surgery. New England Journal of Medicine, 2004. 351(27): p. 2795-2804.
 
[34]  Meyers, J.R., et al., Changes in functional residual capacity of the lung after operation. Arch Surg, 1975. 110(5): p. 576-83.
 
[35]  Abdelsattar, Z.M., et al., The Impact of Untreated Obstructive Sleep Apnea on Cardiopulmonary Complications in General and Vascular Surgery: A Cohort Study. Sleep, 2015. 38(8): p. 1205-10.
 
[36]  Katsura, M., et al., Preoperative inspiratory muscle training for postoperative pulmonary complications in adults undergoing cardiac and major abdominal surgery. Cochrane Database Syst Rev, 2015(10): p. Cd010356.
 
[37]  Brooks-Brunn, J.A., Postoperative atelectasis and pneumonia. Heart Lung, 1995. 24(2): p. 94-115.
 
[38]  Lynch, J.P., 3rd, Hospital-acquired pneumonia: risk factors, microbiology, and treatment. Chest, 2001. 119(2 Suppl): p. 373s-384s.
 
[39]  Guimaraes, M.M., et al., Incentive spirometry for prevention of postoperative pulmonary complications in upper abdominal surgery. Cochrane Database Syst Rev, 2009(3): p. Cd006058.
 
[40]  do Nascimento Junior, P., et al., Incentive spirometry for prevention of postoperative pulmonary complications in upper abdominal surgery. Cochrane Database Syst Rev, 2014(2): p. Cd006058.
 
[41]  Kohl, B.A. and S. Schwartz, How to manage perioperative endocrine insufficiency. Anesthesiol Clin, 2010. 28(1): p. 139-55.
 
[42]  Sreedharan, R. and B. Abdelmalak, Diabetes Mellitus: Preoperative Concerns and Evaluation. Anesthesiol Clin, 2018. 36(4): p. 581-597.
 
[43]  Lee Thomas, H., et al., Derivation and Prospective Validation of a Simple Index for Prediction of Cardiac Risk of Major Noncardiac Surgery. Circulation, 1999. 100(10): p. 1043-1049.
 
[44]  Duceppe, E., et al., Canadian Cardiovascular Society Guidelines on Perioperative Cardiac Risk Assessment and Management for Patients Who Undergo Noncardiac Surgery. Can J Cardiol, 2017. 33(1): p. 17-32.
 
[45]  Bilimoria, K.Y., et al., Development and evaluation of the universal ACS NSQIP surgical risk calculator: a decision aid and informed consent tool for patients and surgeons. J Am Coll Surg, 2013. 217(5): p. 833-42.e1-3.
 
[46]  Cohen, M.E., et al., An Examination of American College of Surgeons NSQIP Surgical Risk Calculator Accuracy. J Am Coll Surg, 2017. 224(5): p. 787-795.e1.
 
[47]  Kupeli, E., et al., American Society of Anesthesiologists Classification Versus ARISCAT Risk Index: Predicting Pulmonary Complications Following Renal Transplant. Exp Clin Transplant, 2017. 15(Suppl 1): p. 208-213.
 
[48]  Chung, F., H.R. Abdullah, and P. Liao, STOP-Bang Questionnaire: A Practical Approach to Screen for Obstructive Sleep Apnea. Chest, 2016. 149(3): p. 631-8.
 
[49]  DeFilippis, A.P., et al., Assessment and Treatment of Patients With Type 2 Myocardial Infarction and Acute Nonischemic Myocardial Injury. Circulation, 2019. 140(20): p. 1661-1678.
 
[50]  Thygesen, K., et al., Third universal definition of myocardial infarction. Circulation, 2012. 126(16): p. 2020-35.
 
[51]  Horr, S., G. Reed, and V. Menon, Troponin elevation after noncardiac surgery: Significance and management. Cleve Clin J Med, 2015. 82(9): p. 595-602.
 
[52]  Botto, F., et al., Myocardial injury after noncardiac surgery: a large, international, prospective cohort study establishing diagnostic criteria, characteristics, predictors, and 30-day outcomes. Anesthesiology, 2014. 120(3): p. 564-78.