What is included in postoperative cardiac management?

Updated: Feb 04, 2019
  • Author: Davinder Jassal, MD; Chief Editor: William A Schwer, MD  more...
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Answer

Historically, postoperative MI carried a grave prognosis (ie, >50% mortality rate). Postoperative ischemia is well characterized, with its peak incidence within 48 hours of surgery. Postoperative ischemia is clinically silent in more than 90% of cases. The Perioperative Ischemia Research Group evaluated the use of continuous echocardiographic monitoring perioperatively and found that ischemia occurred most frequently on postoperative days 1 and 2 (ie, 20% preoperative, 25% intraoperative, 55% postoperative). Because postoperative ischemia can be more deleterious than ischemia detected at other times, interventions, including the perioperative use of beta-blockers and high-dose narcotic analgesia to reduce postoperative pain, are recommended.

The PeriOperative Ischemic Evaluation (POISE) trial was a cohort study of 8351 patients undergoing noncardiac surgery who had troponin levels routinely checked 3 days after surgery. Myocardial infarction was defined as elevated troponin with clinical, ECG, or imaging evidence of myocardial ischemia. The 30-day mortality rate was 5-fold higher in patients with postoperative MI (11.6% vs 2.2%) and was similar between those with and without ischemic symptoms. [11]

A study by Puelacher et al that included 2018 patients who underwent noncardiac surgery reported that perioperative myocardial injury occurred in 16% of surgeries. The adjusted risk of death with perioperative myocardial injury was almost three times higher at 30 days (HR 2.7) and almost two times higher at 1 year (HR 1.6). [12, 13]


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