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Function: insertAPISummary
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Purpose Of Review: One million people die annually following noncardiac surgery and 4% of patients suffer an adverse cardiac event after surgery. As the number of people having surgery grows, our ability to risk stratify patients becomes more important, particularly in the setting of perioperative myocardial ischemia/necrosis.
Recent Findings: In recent publications, an increased troponin following noncardiac surgery has been associated with a higher morbidity/mortality in the perioperative setting. The level of troponin elevation associated with increased morbidity/mortality is now believed to be far lower than was previously considered to be pathologic.
Summary: The presence of troponin elevations following noncardiac surgery, particularly in at-risk patients, may enable practitioners to better identify high-risk patients in the postoperative setting. After recognizing those patients at increased risk for poor outcomes, practitioners can then make interventions, which may decrease the patients' in-hospital, 30-day and potentially long-term mortality.
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http://dx.doi.org/10.1097/MCC.0b013e3283632f33 | DOI Listing |
Int J Surg
December 2024
Senior Department of General Surgery, the First Medical Center of Chinese PLA General Hospital, Beijing, China.
Abstract: We aim to investigate the optimal timing for surgical interventions to maximize patient benefit.
Background: The guidelines recommending a minimum deferral of six months for non-cardiac surgeries following drug-eluting stent percutaneous coronary intervention (DES-PCI) do not adequately address the requirements for individuals undergoing gastrointestinal cancer surgery (GCS).
Methods: The study encompassed 2,501 patients treated from January 2017 to December 2021, all of whom underwent GCS within one year after DES-PCI.
J Cardiothorac Surg
December 2024
Nanjing Medical University, Longmian Avenue No.101, Jiangning District, Nanjing, Jiangsu, China.
Background: Postoperative delirium (POD) is a cognitive decline and attention deficit that can occur in patients after cardiac surgery. Despite extensive research identifying the risk factors, POD often remains undiagnosed and untreated in medical settings. Therefore, this systematic literature review (SLR) aimed to summarize the available studies on early POD identification in patients following cardiovascular surgery.
View Article and Find Full Text PDFBr J Anaesth
December 2024
Translational Medicine and Therapeutics, William Harvey Research Institute, Queen Mary University of London, London, UK. Electronic address:
Background: Hypertension therapy in older adults is often suboptimal, in part because of inadequate suppression of the renin-angiotensin-aldosterone system (RAAS). We hypothesised that distinct endotypes of RAAS activation before noncardiac surgery are associated with increased risk of myocardial injury.
Methods: This was a prespecified exploratory analysis of a multicentre randomised controlled trial (ISRCTN17251494) which randomised patients ≥60 yr old undergoing elective noncardiac surgery to either continue or stop RAAS inhibitors (determined by pharmacokinetic profiles).
Comput Methods Programs Biomed
December 2024
Department of Cardiovascular Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China. Electronic address:
Background And Objective: Accurate prediction of perioperative major adverse cardiovascular events (MACEs) is crucial, as it not only aids clinicians in comprehensively assessing patients' surgical risks and tailoring personalized surgical and perioperative management plans, but also for information-based shared decision-making with patients and efficient allocation of medical resources. This study developed and validated a machine learning (ML) model using accessible preoperative clinical data to predict perioperative MACEs in stable coronary artery disease (SCAD) patients undergoing noncardiac surgery (NCS).
Methods: We collected data from 9171 adult SCAD patients who underwent NCS and extracted 64 preoperative variables.
Can J Anaesth
December 2024
Department of Anesthesia, St. Paul's Hospital/Providence Health Care, Vancouver, BC, Canada.
Approximately 320 million surgeries occur annually worldwide, increasingly performed on an ageing, comorbid population in whom postoperative complications contribute significantly to mortality. While anesthesiologists have led advances in perioperative care, the optimal structure of the provision of postoperative care has lacked discourse. In this article, we describe the implementation, structure, role, and benefits of an Anesthesiology Perioperative Outreach Service (APOS) at a Canadian tertiary hospital, providing proactive daily review and management of high-risk surgical patients.
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