Timing of Surgery

  • Emergency surgery (acute life- or limb-threatening condition)

    • Recommend against delaying surgery for risk assessment

  • Urgent (e.g. acute bowel obstruction, hip #) or semiurgent surgery (e.g. surgery for cancer w/ potential to metastasize)

    • Preop risk assessment if pt’s history/physical exam suggests potential undiagnosed severe obstructive intracardiac abnormality, severe pHTN, or unstable cardiovascular condition (e.g. unstable angina, acute stroke)

  • Elective surgery

    • Preop risk assessment if ≥45 yrs or 18-44 yrs w/ known significant CVS disease

 

         Significant CVS Disease

  • CAD

  • CVD

  • PVD

  • CHF

  • Severe pHTN

  • Severe obstructive intracardiac abnormality (aortic stenosis, mitral stenosis, HOCM)

 

 

Adapted from Canadian Cardiovascular Society Guidelines on Perioperative Cardiac Risk Assessment and Management for Patients Who Undergo Noncardiac Surgery. Canadian Journal of Cardiology. January 2017, Volume 33, Issue 1, Pages 17–32