![]() ![]() 5 Furthermore, established cardiovascular risk calculators and American Heart Association/American College of Cardiology perioperative guidelines do not incorporate laparoscopic approach when characterizing operative risk. 4 Newer scores have been studied in patients undergoing open or laparoscopic surgery, such as the American College of Surgeons’ National Surgical Quality Improvement Program Myocardial Infarction or Cardiac Arrest score, which accounts for differences in surgical procedures based on organ system analyses restricted to risk prediction in laparoscopic patients have not been published. Frequently used risk assessment tools, such as the Revised Cardiac Risk Index, have not been validated in patients undergoing laparoscopic surgery. 2, 3 Laparoscopic surgery is frequently utilized in higher risk patient groups, including the elderly, obese patients, and in those with preexisting conditions, including cardiovascular and pulmonary diseases. 1 Although the overall mortality of laparoscopic surgery is low, ranging from 0.3% to 1.8%, preoperative consultation to estimate the risk of perioperative cardiovascular events is common. Laparoscopic surgery accounts for >2 million surgical procedures per year in the United States with cholecystectomy, appendectomy, colectomy, Roux-en-Y gastric bypass, sleeve gastrectomy, and hysterectomy among the most performed. Prevention of cardiovascular complications may be accomplished through a sound understanding of the hemodynamic and physiological consequences of laparoscopic surgery as well as a defined operative plan generated by a multidisciplinary team involving the preoperative consultant, anesthesiologist, and surgeon. Hemodynamic effects are accentuated in patients with cardiovascular disease such as congestive heart failure, ischemic heart disease, valvular heart disease, pulmonary hypertension, and congenital heart disease. Hemodynamic insults secondary to increased intraabdominal pressure include increased afterload and preload and decreased cardiac output, whereas ventilatory consequences include increased airway pressures, hypercarbia, and decreased pulmonary compliance. During laparoscopic surgery, carbon dioxide insufflation may produce significant hemodynamic and ventilatory consequences such as increased intraabdominal pressure and hypercarbia. In general, laparoscopic procedures have a lower risk of morbidity and mortality compared with operations requiring a midline laparotomy. Customer Service and Ordering InformationĪlthough laparoscopic surgery accounts for >2 million surgical procedures every year, the current preoperative risk scores and guidelines do not adequately assess the risks of laparoscopy.Stroke: Vascular and Interventional Neurology.Journal of the American Heart Association (JAHA).Circ: Cardiovascular Quality & Outcomes.Arteriosclerosis, Thrombosis, and Vascular Biology (ATVB). ![]()
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