From the Guidelines
Contraindications for general surgery include active major bleeding, severe uncontrolled malignant hypertension, severe uncompensated coagulopathy, and high-risk invasive procedures in critical sites, as these conditions significantly increase the risk of morbidity and mortality. When considering surgery, it is crucial to assess the patient's overall health status and potential risks associated with the procedure. According to the most recent guidelines, absolute contraindications to anticoagulation, which can be applied to general surgery, include active major, serious, or potentially life-threatening bleeding not reversible with medical or surgical intervention, as outlined in the study by 1.
Key Contraindications
- Active major bleeding
- Severe uncontrolled malignant hypertension
- Severe uncompensated coagulopathy (e.g., liver failure)
- High-risk invasive procedure in a critical site (e.g., lumbar puncture, spinal anesthesia, epidural catheter placement)
- Severe platelet dysfunction or inherited bleeding disorder
- Persistent, severe thrombocytopenia (<20,000/mL)
Relative contraindications, where the risk of recurrent or progressive thrombosis may exceed the risk of bleeding, include intracranial or spinal lesions at high risk for bleeding, active GI ulceration at high risk of bleeding, and recent high-risk surgery or bleeding events, as noted in 1 and supported by the principles outlined in 1.
Considerations for Anticoagulation
- Patients on anticoagulants should have their medication managed appropriately before surgery, with consideration for bridging therapy if necessary.
- The decision to proceed with surgery despite contraindications should be based on a thorough risk-benefit analysis, considering the potential for complications such as myocardial infarction, stroke, acute kidney injury, or respiratory failure.
- Emergency life-saving procedures may sometimes proceed despite contraindications when the immediate risk of not operating exceeds the surgical risk, emphasizing the need for individualized decision-making in the context of general surgery.
From the Research
Contraindications for General Surgery
- The provided studies do not directly address contraindications for general surgery. However, they discuss various conditions and risk factors related to cardiac health that may be relevant when considering surgery.
- Conditions such as acute coronary syndrome 2, 3, unstable angina 4, 5, 6, and non-ST-segment elevation myocardial infarction 3, 6 may be contraindications for non-emergency general surgery due to the increased risk of cardiac complications.
- Risk factors such as age (at least 65 years), smoking, hypertension, diabetes mellitus, hyperlipidemia, and a family history of premature coronary artery disease 2 may also be considered when evaluating a patient's suitability for general surgery.
- The presence of chest pain or discomfort, especially if it is indicative of cardiac origin, should be carefully evaluated before proceeding with general surgery 4, 3.
- Electrocardiography changes, such as ST depression, ST elevation, T-wave inversion, or the presence of Q waves, may also be relevant when assessing a patient's cardiac risk before surgery 2, 3.