Letter to the Editor
As an anaesthetist, I read the article ‘Preoperative assessment: a cardiologist’s perspective’ (Aust Prescr 2014;37:188-91) with much interest. The statement that ‘risk assessment before surgery aims to minimise potential perioperative complications’ is likely correct, although there is regrettably little evidence to substantiate this claim. However, I dispute the authors’ view that for emergency surgery ‘preoperative assessment uncommonly alters the course or outcome’.
The 2014 American College of Cardiology/American Heart Association guidelines recommend that, even for emergency surgery, clinical risk stratification should be undertaken, and that patients’ morbidity and mortality risk can be estimated with the use of validated tools (www.riskcalculator.facs.org and www.riskprediction.org.uk/pp-index.php ). Discussion of morbidity and mortality risk enables shared decision making, including the possibility that patients may decline surgery.
High-risk surgical patients have been described as those with a predicted postoperative mortality of greater than 5%.1 A 2011 report from the UK National Confidential Enquiry into Patient Outcome and Death suggests that high-risk surgical patients should be carefully considered for postoperative high-dependency or intensive care.2
Disturbingly, in Australia (unlike New Zealand) good data on system-wide postoperative mortality are not collected and publicly reported. Clearly, not all postoperative morbidity and mortality is cardiac.
Conjoint associate professor, UNSW Rural Clinical School
VMO Anaesthetist, Coffs Harbour Health Campus
Coffs Harbour, NSW
- Pearse RM, Harrison DA, James P, Watson D, Hinds C, Rhodes A. Identification and characterisation of the high-risk surgical population in the United Kingdom. Crit Care 2006;10:0.
- Findlay GP, Goodwin AP, Protopapa K, Smith NC, Mason M. Knowing the risk: a review of the peri-operative care of surgical patients. London: National Confidential Enquiry into Patient Outcome and Death; 2011. .
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