A practical approach to perioperative risk optimisation for non-cardiac surgery

Abstract

The combination of careful perioperative considerations, less invasive surgeries and the liberal use of neuro-axial techniques has decreased perioperative major adverse cardiac events (MACE) and overall mortality in vascular surgical patients.

Despite this, the recently published ASOS-2 study still demonstrated a 1% mortality even with intensive postoperative monitoring for a range of patients and procedures in lower-middle income countries (LMICs).¹ As surgeons, our outcome measures are sometimes different to other perioperative physicians (primarily anaesthesiologists and cardiologists). Our outcomes are not limited to the myocardial function or the safe awakening after anaesthesia, but also incorporates medium term outcomes such as postoperative infections, wound healing, returns to the operating theatre and restoration of pre-morbid functional capacity.