Cardiovascular Disease: The top non-communicable disease in the Bahamas.

What are the surgery risks associated with CAD?

A non-communicable disease (NCD) is defined by the World Health Organization (WHO) as a disease of long duration and generally slow progression such as cardiovascular diseases, cancer, chronic respiratory diseases (like asthma) and diabetes. NCDs are the leading cause of death in the world and kill more than 36 million people every year accounting for 63% of deaths worldwide. A 2014 report by the Pan American Health Organization (PAHO) cites Heart disease, Cancer and Diabetes as the top three NCDs in the Bahamas. Cardiovascular disease is the top NCD in the Bahamas.

When a patient suffering from cardiovascular disease must seek non-cardiac surgery, Perioperative myocardial infarction (or heart attack) is a major risk. Approximately 20 to 40 percent of patients at high risk of cardiac-related morbidity develop myocardial ischemia perioperatively (aafp.org).

Risk is determined by the medical condition of the patient, age, the invasiveness of the surgery and the type of anesthesia that will be used. CAD patients undergoing non-cardiac surgery are  grouped into two risk categories: major and minor. Whereas all CAD patients should have their risk assessment determined, there are only some cases, in which further testing may be required to determine what the appropriate approach should be.

Major non-cardiac surgery or emergency surgery.

Patients whose rate of mortality is higher than one percent are considered major risk patients. In the case of major non-cardiac surgery or emergency surgery,  patients need further evaluation which may include: stress testing, echocardiography, 24 hour ambulatory monitoring or cardiologist consultation. Medical therapy using beta blockers, statins, and alpha agonists may also be effective in high-risk patients.

Minor non-cardiac or elective non-cardiac surgery.

Patients whose estimated risk of mortality is one percent or less are considered low risk. Low risk patients may not require any additional testing whatsoever especially if they are undergoing elective surgery.

Conclusion

Cardiovascular disease is a serious condition that effects more than half of Bahamas’ population. Before undergoing non-cardiac surgery on a patient with CAD, the physician must first assess whether the situation requires emergency surgery. If not, further assessment can be pursued based on specific risk factors. Studies have shown that single incision laparoscopic surgery (SILS) is a technique that is both feasible and safe for many surgical procedures.

Sources cited:

Preparation of the Cardiac Patient for Noncardiac Surgery, American Family Physician,  www.aafp.org; Preoperative evaluation and preparation for anesthesia and surgery, ncbi.nlm.nih.gov ; Complications in Surgery by Michael W. Mulholland MD PhD; Evaluation of Cardiac risk prior to non-cardiac surgery, www.uptodate.com .