What is the level of severity of bunion orthopedic surgery according to pre-operative cardiac guidelines?

From the Guidelines

Bunion orthopedic surgery is generally classified as low-risk surgery according to pre-operative cardiac guidelines, with a cardiac risk typically less than 1%. This classification is based on the procedure's limited hemodynamic stress and blood loss. For most healthy patients undergoing bunion surgery, no additional cardiac testing is required beyond standard pre-operative assessment, as stated in the 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery 1. However, patients with known cardiac disease or significant risk factors may need further evaluation. The surgical stress from bunion procedures is relatively minimal compared to major orthopedic surgeries like joint replacements. Most bunion surgeries can be performed on an outpatient basis with regional anesthesia, which further reduces cardiac stress.

Some key points to consider in the pre-operative cardiac evaluation of patients undergoing bunion surgery include:

• The type of surgery and its associated cardiac risk, as outlined in the 2014 ESC/ESA guidelines on non-cardiac surgery: cardiovascular assessment and management 1
• The patient's clinical risk factors, such as a history of coronary heart disease or heart failure
• The need for further cardiac testing, such as an electrocardiogram (ECG) or echocardiogram, in patients with known cardiac disease or significant risk factors
• The importance of continuing medical therapy, such as beta-blockers or statins, in patients with known cardiac disease or risk factors, as recommended in the 2014 ESC/ESA guidelines 1

It is essential to note that individual patient factors always need consideration, and patients with multiple cardiac risk factors should discuss their specific situation with their surgeon and possibly consult with a cardiologist before proceeding with even this relatively low-risk procedure. The classification as low risk means that cardiac complications are uncommon in this procedure, but careful evaluation and management can help minimize the risk of cardiac morbidity and mortality, as emphasized in the 2009 ACCF/AHA focused update on perioperative beta blockade 1.

From the Research

Bunion Orthopedic Surgery Severity

According to pre-operative cardiac guidelines, the level of severity of bunion orthopedic surgery is considered low to moderate risk.

• The American College of Cardiology and American Heart Association guidelines do not specifically mention bunion surgery, but they do provide a framework for assessing cardiac risk for noncardiac surgery 2, 3.
• The guidelines suggest that patients without risk factors are considered to be at low risk, while patients with 1 or 2 cardiac risk factors represent an intermediate-risk group for perioperative cardiac complications 2.
• Bunion orthopedic surgery is generally considered to be a low to moderate risk procedure, and patients undergoing this surgery are typically assessed as low to intermediate risk according to the Revised Cardiac Risk Index (RCRI) score 4, 5.
• The Canadian Cardiovascular Society Guidelines recommend measuring brain natriuretic peptide (BNP) or N-terminal fragment of proBNP (NT-proBNP) before surgery to enhance perioperative cardiac risk estimation in patients who are 65 years of age or older, or have significant cardiovascular disease 6.
• However, there is no specific evidence to suggest that bunion orthopedic surgery is considered high-risk according to pre-operative cardiac guidelines.

Cardiac Risk Assessment

The assessment of cardiac risk for patients undergoing bunion orthopedic surgery involves evaluating the patient's clinical risk factors, functional status, and the estimated stress of the planned surgical procedure 4, 5.

• The stepwise approach to preoperative cardiovascular risk assessment includes establishing the risk of surgery per se, evaluating the presence of unstable cardiac conditions, assessing functional capacity, and determining the value of non-invasive and/or invasive cardiovascular testing 4.
• The Revised Cardiac Risk Index (RCRI) score and the National Surgical Quality Improvement Program (NSQIP) are validated scores used to estimate perioperative risk for major cardiac adverse events 4, 5.