Novel Insights in Perioperative Care

Atherothrombosis is a major worldwide health problem and will continue to be the leading cause of mortality in the next decade. By definition, patients undergoing vascular surgery have established atherothrombosis in one vascular bed. However the prevalence of polyvascular disease, defined as symptomatic involvement of more than one vascular bed, in these patients is high. For patients undergoing non-cardiac surgery, the risk of postoperative adverse cardiovascular events is estimated by the use of preoperative risk scores, particularly the Revised Cardiac Risk Index. We have evaluated the value of non-traditional risk factors, like aortic valve calcification, ABO blood type, hemoglobin, blood transfusions and Body Mass Index (BMI), on postoperative and long-term outcome in patients undergoing non-cardiac surgery and found that, except for ABO blood type, each of these risk factors contributed to adverse outcomes. Although the results of our studies suggest the use of these ‘novel’ risk factors in the estimation of the postoperative cardiovascular event and long-term mortality risk, it is probably most important to recognize and adequately treat the underlying comorbidity that is responsible for the negative outcomes, particularly coronary heart disease. Therefore, the primary focus for all patients with atherothrombotic disease should be on optimal risk factor control with medical therapy and lifestyle interventions according to guideline recommendations in order to prevent future cardiovascular events.

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