Medical optimization of patients prior to surgery

Abstract

Evaluating the orthopedic patient for revision of a periprosthetic hip or knee joint infection follows the same algorithm as preoperative evaluation for general noncardiac surgery. Dreaded complications of any noncardiac surgery are myocardial infarction (MI) and death. In the aging population, the number one cause of death is cardiovascular disease, though with current therapies that include a growing list of newer antiplatelet agents, coronary artery stents, beta-blockers, and statin therapies, the rates of cardiovascular death have been on the decline over the last 2-3 decades. Heart failure (HF) and arrhythmias, such as atrial fibrillation, also complicate noncardiac surgery; and it is worth noting that for the first time in some 50 years, new oral anticoagulants have been approved for nonvalvular atrial fibrillation stroke prevention. This chapter reviews the medical management of a host of primarily cardiovascular diseases and updates the reader on the latest medical therapies and perioperative management of these conditions.