Heart Care Info - Heart Disease Prevention & Treatment

Surgery and cardiovascular outcomes: an untapped public health benefit that potentially saves lives

BM Biccard - Anaesthesia, 2012 - Wiley Online Library... the access to appropriate health interventions [23]. Ineligibility for surgery could theoretically result in the initiation of two pathways associated with inequality in cardiovascular health. Patients ineligible for surgery may have ... [HTML]

The study by Mac Farlane and colleagues suggests that there is a net cardiovascular benefit from hospitalisation for surgery in low to intermediate risk patients in comparison with hospitalisation without surgery, and importantly in the intermediate to long term [1]. However, I believe that this cardioprotection may not be associated with the surgery itself, but rather, is secondary to other factors. I would propose that the evidence suggests a net cardiovascular harm associated with surgery. Firstly, any potential preconditioning intervention, be it pre infarction angina and ischaemia, volatile anaesthesia, or the interesting suggestion of a limited inflammatory insult [1], are all, at best, short term phenomena with short term cardiovascular protection [10, 11]. In addition, the clinical evidence for volatile protection in non cardiac surgery continues to remain controversial [12], and the evidence for preconditioning is particularly lacking in the intermediate term [11, 13], and it is here that Mac Farlane and colleagues have suggested benefit [1]. Probably, the most likely cardioprotective intervention associated with surgery is the removal of an inflammatory focus, although this benefit won t be realised by all patients, as a large proportion of surgical patients do not have inflammatory disease. Markers of both pre operative [14] and postoperative inflammation [15] have been associated with intermediate term morbidity or mortality, although admittedly this has been in vascular surgical patients.