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Update in Perioperative Medicine
- Gerald W. Smetana, MD;
- Steven L. Cohn, MD; and
- Valerie A. Lawrence, MD
- From Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts; State University of New York Downstate Medical Center, Brooklyn, New York; VERDICT (A VHA Health Services Research Center of Excellence), South Texas Veterans Health Care System, and the University of Texas Health Center, San Antonio, Texas.
Medical consultation for patients preparing for surgery is an important activity for internists. Many clinicians may, however, feel unprepared for this role because the science and clinical recommendations do not follow intuitively from the day-to-day care of medical patients in the office or the hospital. Over the past 3 decades, this field has evolved from one of clinical experience and anecdote to a more evidence-based discipline. We present this first Update in Perioperative Medicine to review recent key articles and advances in this field.
We polled colleagues and used a systematic search strategy to identify articles of particular relevance for the medical care of patients before surgery. We searched MEDLINE for the period from 1 January 2001 through 30 August 2003. Medical Subject Heading terms included intraoperative complications, postoperative complications, preoperative care, intraoperative care, perioperative care, postoperative care, intraoperative period, and preoperative period; we also included the following text words in the title or abstract: intraoperative OR postoperative OR perioperative AND complication OR event. We excluded articles related to transplantation, cardiac, and pediatric surgery. We ran this search monthly during the eligible period and selected studies that were methodologically sound, were of interest to practicing internists, addressed common and morbid postoperative outcomes, and could potentially change the approach to diagnosis, risk stratification, or prevention of postoperative medical complications. Each author independently generated a list of articles for potential inclusion; we determined the final list by consensus.
We consider here 5 broad topic areas: cardiac risk stratification and risk reduction strategies, preoperative pulmonary evaluation, venous thromboembolism prophylaxis, diabetes mellitus, and postoperative delirium.
Cardiac Risk Stratification and Risk Reduction Strategies
β-Blockers Reduce Perioperative Cardiac Morbidity and Mortality
The literature on perioperative β-blocker therapy has evolved from small observational studies to hypothesis-testing randomized clinical trials and now a systematic review of trial evidence. The authors searched MEDLINE for reports published since 1980 and reviewed …
