From the Guidelines
Perioperative clearance should prioritize a comprehensive assessment of patient-related risk factors, including age, chronic lung disease, and functional dependence, to determine the risk of postoperative pulmonary complications, as outlined in the American College of Physicians guideline 1.
Key Considerations
- Patient-related risk factors, such as advanced age, chronic lung disease, and functional dependence, are significant predictors of postoperative pulmonary complications 1.
- A systematic approach to perioperative clearance should include evaluating these risk factors and developing strategies to reduce the risk of postoperative pulmonary complications.
- The American College of Physicians guideline 1 provides a framework for clinicians to guide patients undergoing noncardiothoracic surgery and to evaluate the efficacy of strategies to reduce the risk of postoperative pulmonary complications.
Recommendations
- Clinicians should assess patient-related risk factors, including age, chronic lung disease, and functional dependence, to determine the risk of postoperative pulmonary complications.
- Strategies to reduce the risk of postoperative pulmonary complications should be implemented, such as optimizing chronic lung disease management and improving functional dependence.
- The perioperative period should be defined as 2 to 3 months before surgery and up to 3 months after surgery, as outlined in the American College of Physicians guideline 1.
Management
- Clinicians should prioritize a comprehensive assessment of patient-related risk factors to determine the risk of postoperative pulmonary complications.
- The American College of Physicians guideline 1 should be used as a framework to guide clinicians in the perioperative management of surgical patients.
- Strategies to reduce the risk of postoperative pulmonary complications should be tailored to the individual patient's risk factors and medical status.
From the Research
Perioperative Clearance
- The provided studies do not directly address perioperative clearance.
- However, they discuss the effects of various antidiabetic medications on cardiovascular outcomes and heart failure in patients with diabetes mellitus 2, 3, 4, 5, 6.
- Some studies suggest that certain antidiabetic medications, such as SGLT-2 inhibitors and GLP-1 receptor agonists, may have beneficial effects on cardiovascular outcomes and heart failure compared to insulin therapy 2, 4.
- Other studies found that insulin therapy did not differ from oral hypoglycemic agents in terms of all-cause mortality and cardiovascular outcomes in patients with type 2 diabetes 6.
- The effects of antidiabetic medications on perioperative clearance are not explicitly discussed in the provided studies.
Relevant Findings
- A study published in BMJ open diabetes research & care found that SGLT-2 inhibitors and GLP-1 receptor agonists significantly reduced major adverse cardiac events compared to insulin therapy in patients with diabetes mellitus and heart failure 2.
- A review published in the Lancet discussed the relationship between glycaemic control and heart failure risk, highlighting the need for new glucose-lowering drugs to show cardiovascular safety 3.
- A study published in Heart failure reviews summarized the impact of glucose-lowering agents on cardiovascular safety and heart failure-associated outcomes, noting that SGLT2 inhibitors have been shown to reduce the incidence of heart failure and cardiovascular mortality 4.
- A narrative review published in the European journal of endocrinology discussed the effects of oral hypoglycaemic agents on cardiovascular disease in patients with type 2 diabetes, highlighting the uncertain effect of glitazones on cardiovascular disease 5.
- A meta-analysis published in Clinical therapeutics found that insulin therapy did not differ from oral hypoglycemic agents in terms of all-cause mortality and cardiovascular outcomes in patients with type 2 diabetes 6.