Noncardiac Surgery Guidelines Updated

August 1st, 2014

Noncardiac Surgery Guidelines Updated

Larry Husten, PHD

The reliability of current guidelines regarding perioperative evaluation and treatment of people undergoing noncardiac surgery has been seriously questioned because of a scandal discrediting Don Poldermans, a Dutch researcher widely published in the field. To address the current uncertainty, U.S. and European medical societies today released updated versions of these guidelines. The European guideline can be found here and the U.S. guideline can be found here.

“Given the recent publication of several large-scale trials, including POISE-II, and new risk calculators, as well as the controversy regarding the use of beta blockers related to the DECREASE trials, the writing committee felt it was necessary to reevaluate all of the data on cardiovascular care for the patient undergoing noncardiac surgery,” said U.S. Writing Committee Chair Lee Fleisher, in a press release.

Regarding beta-blockers, the subject of much of the controversy and concern, the U.S. and European guidelines now do not recommend routine use in patients who undergo non-cardiac surgery, though people who are already taking beta-blockers should continue taking them. (Previously the European guideline did support routine use of beta-blockers.) Both guidelines state that beta-blocker therapy may be initiated prior to surgery in carefully selected higher-risk patients.

Both the European and U.S. guidelines say that preoperative initiation of statin therapy may be considered in patients undergoing vascular surgery. People already taking statins should continue taking them.

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CardioExchange, an NEJM practice community for medical professionals dedicated to improving cardiac patient care, was active from 2009 to 2015. CardioExchange fostered discussion between clinicians from across the globe.

August 1st, 2014