Improving decision-making for timing of surgery for high-risk

Br J Anaesth · Nov 2024

Editorial

Improving decision-making for timing of surgery for high-risk comorbid patients.

Deciding the optimal time for surgery in patients with pre-existing comorbid disease is complex. A careful balance of risks is required to weigh up the therapeutic benefits of surgery against an increased risk of perioperative adverse outcomes, whereas the subsequent risk of adverse events and mortality is more dependent on pre-existing conditions. A study in a recent issue of BJA shows that people with a previous cardiovascular or cerebrovascular event within 10 yr of elective surgery were at a higher risk of major adverse cardiovascular events within 1 yr from surgery and that an at-risk period existed if surgery occurred within 37 months of the preoperative event. Before this observation can be used to inform clinical decision-making, caution is needed to interpret these findings because of biases introduced by the analytical approach and potential confounding.

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- Yize I Wan and Stefano Savonitto.
- William Harvey Research Institute, Queen Mary University of London, London, UK; Acute Critical Care Research Unit, Royal London Hospital, Barts Health NHS Trust, London, UK. Electronic address: yize.wan@qmul.ac.uk.
- Br J Anaesth. 2024 Nov 11.
AbstractDeciding the optimal time for surgery in patients with pre-existing comorbid disease is complex. A careful balance of risks is required to weigh up the therapeutic benefits of surgery against an increased risk of perioperative adverse outcomes, whereas the subsequent risk of adverse events and mortality is more dependent on pre-existing conditions. A study in a recent issue of BJA shows that people with a previous cardiovascular or cerebrovascular event within 10 yr of elective surgery were at a higher risk of major adverse cardiovascular events within 1 yr from surgery and that an at-risk period existed if surgery occurred within 37 months of the preoperative event. Before this observation can be used to inform clinical decision-making, caution is needed to interpret these findings because of biases introduced by the analytical approach and potential confounding.Copyright © 2024 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.

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Improving decision-making for timing of surgery for high-risk comorbid patients.

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