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elective surgery

Classification: - includes: surgery scheduled in advanced - excludes: urgent surgery Complications: - risk for death is higher for patients who undergo elective surgery later in the week or on weekends compared with risk for those who undergo procedures early in the week [3] - history of stroke within 30 days of surgery increases risk of perioperative stroke [6] - elective surgery does not increase the rate of incident dementia over a 5 year period vs nonsurgical controls [9] Management: - allows for autologous blood donation - no demonstrated benefit for mandatory prescription drug monitoring [4] - delay surgery until stabilization of acute condition, including (but not limited to) acute heart failure, anemia, hypothyroidism, COPD [5] - delay elective surgery at least 6-9 months after ischemic stroke [7] - delay elective surgery after PCI [8] - 1-4 weeks for recipients of PCI without stents - 4-6 weeks for recipients of PCI with bare metal stents - >= 3-6 months recipients of PCI with drug-eluting stents - hold clopidogrel 5-7 days prior to surgery, continue low dose aspirin - hold prasugrel 7 days & ticagrelor 3-5 days prior to surgery - witholding low-dose aspirin & clopidogrel may be reasonable if bleeding risk is extreme or consequences catastrophic, as with neurosurgery - delay or cancel elective surgery for patients with pulmonary hypertension [6] - avoid elective surgery if liver disease with MELD score > 14 [6] * see particular disorder for references

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surgery

References

  1. Wikipedia: Elective surery http://en.wikipedia.org/wiki/Elective_surgery
  2. Encyclopedia of Surgery: Elective Surgery http://www.surgeryencyclopedia.com/Ce-Fi/Elective-Surgery.html
  3. Aylin P et al. Day of week of procedure and 30 day mortality for elective surgery: Retrospective analysis of hospital episode statistics. BMJ 2013 May 28; 346:f2424 PMID: 23716356
  4. Stucke RS, Kelly JL, Mathis KA et al Association of the Use of a Mandatory Prescription Drug Monitoring Program With Prescribing Practices for Patients Undergoing Elective Surgery JAMA Surg. Published online August 22, 2018 PMID: 30140927 https://jamanetwork.com/journals/jamasurgery/fullarticle/2696623
  5. NEJM Knowledge+ Question of the Week. July 14, 2020 https://knowledgeplus.nejm.org/question-of-week/195/ - Lerman BJ, Popat RA, Assimes TL et al. Association of left ventricular ejection fraction and symptoms with mortality after elective noncardiac surgery among patients with heart failure. JAMA 2019 Feb 12; 321:572. PMID: 30747965 Free PMC article
  6. Medical Knowledge Self Assessment Program (MKSAP) 14, 15, 16, 17, 18, 19. American College of Physicians, Philadelphia 2006, 2009, 2012, 2015, 2018, 2022.
  7. Medical Knowledge Self Assessment Program (MKSAP) 11, 14, 15, 16, 17, 18, 19. American College of Physicians, Philadelphia 1998, 2006, 2009, 2012, 2015, 2018, 2021. - Jorgensen ME et al. Time elapsed after ischemic stroke and risk of adverse cardiovascular events and mortality following elective noncardiac surgery. JAMA 2014 Jul 16; 312:269. PMID: 25027142 - Benesch C, Glance LG, Derdeyn CP et al Perioperative Neurological Evaluation and Management to Lower the Risk of Acute Stroke in Patients Undergoing Noncardiac, Nonneurological Surgery: A Scientific Statement From the American Heart Association/American Stroke Association. Circulation. 2021. Oct 8 PMID: 33827230 Review. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000968 - Glance LG et al. Association of time elapsed since ischemic stroke with risk of recurrent stroke in older patients undergoing elective nonneurologic, noncardiac surgery. JAMA Surg 2022 Jun 29 PMID: 35767247 https://jamanetwork.com/journals/jamasurgery/fullarticle/2793559
  8. American College of Cardiology Foundation/American Heart Association Task Force, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine, Society for Vascular Surgery, Fleisher LA, Beckman JA, Brown KA, Calkins H, Chaikof EL, Fleischmann KE, Freeman WK, Froehlich JB, Kasper EK, Kersten JR, Riegel B, Robb JF. 2009 ACCF/AHA focused update on perioperative beta blockade incorporated into the ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery. J Am Coll Cardiol 2009 Nov 24;54(22):e13-e118 PMID: 19926002 - Fleisher LA et al, ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for non-cardiac surgery... J Am Coll Cardiol 2007, 50:e159 PMID: 17950140 http://dx.doi.org/10.1016/j.jacc.2007.09.003
  9. Reich KM, Gill SS, Eckenhoff R et al Association between surgery and rate of incident dementia in older adults: A population-based retrospective cohort study. J Am Geriatr Soc 2025. 72(5):1348-1359 PMID: 38165146 https://agsjournals.onlinelibrary.wiley.com/doi/10.1111/jgs.18736