PREOPERATIVE ASSESSMENT OF COMMON DISEASES IN THE OUTPATIENT SETTING

Abstract

Perioperative myocardial infarction (MI) is a major source of morbidity and mortality in surgical patients. Each year an estimated 50,000 patients in the United States experience perioperative and mortality exceeds 20,000 annually.44 The average cost to hospitals is estimated in one source to be $12,000 per ~atient.4~ The risk of perioperative MI is greatly increased in patients with previous infarction within 6 months of 69 and elective outpatient surgery should be postponed in such patients. In patients with previous MI for whom surgery cannot be postponed an appropriate number of weeks, or in patients without prior MI who have coronary artery disease (CAD) or stable angina, the use of preoperative testing can identify which patients are at increased risk of perioperative cardiac ischemia. For patients with recent MI in whom surgery is not completely elective but not truly emergent (e.g., a patient with a resectable malignancy) evaluation of left ventricular function and exercise tolerance may identify patients with relatively small risks. The nature of the surgery to be undertaken has considerable influence over the risks of surgery in patients with CAD. Backer et a1 found that ophthalmologic surgery under local anesthesia was safe, even in patients with recent ML4 The number of patients in the study who underwent ophthalmologic surgery under general anesthesia was small, but they also did well. Transurethral resection of the prostate appears to carry low risk, even in patients with serious heart disease,-*' and many authors suggest that the risks of peripheral extremity procedures is also l0w.7~ Vascular surgery is associated with increased risk.60 The identification of patients with preoperative myocardial ischemia is an important step in identifying patients at increased anesthetic and surgical risk. Slogoff and Keatsm demonstrated that perioperative myocardial ischemia is associated with perioperative MI. Preoperative testing that defines patients at