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Update in Perioperative Medicine
- Steven L. Cohn, MD; and
- Gerald W. Smetana, MD*
- From the State University of New York Downstate Medical Center, Brooklyn, New York, and Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts.
2007 Series: Update Sessions from Internal Medicine 2007
This year's Update in Perioperative Medicine includes discussions of preoperative revascularization, prevention of cardiac and pulmonary complications, and postoperative delirium. Changes to clinical practice emerging from these articles are shown in the Table .
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Preoperative Revascularization
Question: In patients undergoing noncardiac surgery after percutaneous coronary intervention (PCI), are perioperative complications more frequent in those who had coronary stenting than in those who had percutaneous transluminal coronary angioplasty (PTCA) only?
Study Design: Retrospective cohort study using a single institution's computerized database with information from 1995 to 2002.
Patients: 216 patients who had undergone surgery in a 3-month period after PTCA or PCI with stenting.
Setting: Academic medical center (Hadassah University Hospital, Jerusalem, Israel).
Outcomes: Death, myocardial infarction (MI), and major bleeding within 6 months of surgery.
Sponsor: None reported.
Results: Of the 216 patients, 122 had PTCA and 94 had PCI with stent implantation. Except for 1 patient, all received bare-metal stents. Thirteen patients (14%) in the PCI group and 13 patients (11%) in the PTCA group died, a non–statistically significant difference. Incidence of postoperative MI (7% vs. 6%) or major bleeding (16% vs. 13%) did not statistically significantly differ between the groups. More frequent bleeding events and deaths occurred among patients who had surgery fewer than 2 weeks after either intervention than among those who had surgery 2 weeks or more after either intervention. Fewer MIs and cardiac deaths occurred in the PTCA group than in the PCI group among persons undergoing noncardiac surgery within 2 weeks of the intervention (18% vs. 33%), but the differences were not statistically significant because of the small numbers of patients.
Conclusions: In patients undergoing noncardiac surgery after PCI, perioperative complications are no more frequent in those who received coronary stents than in those who had PTCA only. …
