An evidence-based approach to perioperative care: Update for the primary care physician

• Objective: To review the general principles of perioperative care for the primary care physician. • Methods: Qualitative assessment of the literature. • Results: A thorough history and physical examination provides the foundation of the preoperative evaluation. Laboratory testing generally should be performed when indicated rather than as routine screening prior to surgery. The American College of Cardiology and the American Heart Association have published consensus guidelines to guide the clinician on assessing cardiac risk, the potential benefit of noninvasive testing (eg, exercise electrocardiography [ECG], exercise or dobutamine stress echocardiography, and stress myocardial perfusion imaging), and the benefit of various management options. The indications for coronary artery bypass grafting and percutaneous coronary intervention prior to noncardiac surgery are identical to those for patients in which these procedures would otherwise be indicated. β-Blocker therapy has been shown to reduce the risk of perioperative cardiac death or myocardial infarction in selected patients. In patients with high or intermediate clinical risk who have known or suspected coronary artery disease and who are undergoing high or intermediate risk procedures, the most cost-effective strategy for postoperative monitoring is to obtain a 12-lead ECG immediately after surgery and on the first 2 days postoperatively. • Conclusion: With knowledge of established risk factors obtained from a thorough history and physical examination and application of evidence-based guidelines, the physician can order appropriate testing and targeted interventions to maximize beneficial outcomes.