Pre-operative evaluation of adults undergoing elective noncardiac surgery

Abstract

: The purpose of this update of the European Society of Anaesthesiology (ESA) guidelines on the pre-operative evaluation of the adult undergoing noncardiac surgery is to present recommendations based on the available relevant clinical evidence. Well performed randomised studies on the topic are limited and therefore many recommendations rely to a large extent on expert opinion and may need to be adapted specifically to the healthcare systems of individual countries. This article aims to provide an overview of current knowledge on the subject with an assessment of the quality of the evidence in order to allow anaesthesiologists all over Europe to integrate - wherever possible - this knowledge into daily patient care. The Guidelines Committee of the ESA formed a task force comprising members of the previous task force, members of ESA scientific subcommittees and an open call for volunteers was made to all individual active members of the ESA and national societies. Electronic databases were searched from July 2010 (end of the literature search of the previous ESA guidelines on pre-operative evaluation) to May 2016 without language restrictions. A total of 34 066 abtracts were screened from which 2536 were included for further analysis. Relevant systematic reviews with meta-analyses, randomised controlled trials, cohort studies, case-control studies and cross-sectional surveys were selected. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used to assess the level of evidence and to grade recommendations. The final draft guideline was posted on the ESA website for 4 weeks and the link was sent to all ESA members, individual or national (thus including most European national anaesthesia societies). Comments were collated and the guidelines amended as appropriate. When the final draft was complete, the Guidelines Committee and ESA Board ratified the guidelines.

The quality of clinical practice guidelines for preoperative care using the AGREE II instrument: a systematic review

“…[26][27][28] The strength of a recommendation is defined as the extent to which one can be confident that the guidelines also provided independent predictors for difficult mask ventilation, a topic not specifically addressed in previous CPGs. [30] As described, RCTs are still few and therefore many preoperative interventions rely to a large extent on expert opinion, which in turn requires to be adapted to the reality of nations' healthcare systems.…”

“…Studies on prognostic or diagnostic accuracy tests, including scoring of severity of illness, usually provide low quality of evidence, even when scores such as ASA-PS, RCRI, NSQIP-MICA, POSSUM and others have been extensively validated. [30] Our updated overview of EB-CPGs, conducted under the rigorous Cochrane methods, may be a useful resource for the professionals involved in preoperative care to consult during decision-making. We present many strong recommendations with sufficient evidence to be routinely implemented in clinical practice.…”

“…Guideline panels must integrate these factors to make a strong or weak recommendation for or against an intervention [29]. After our search date, the updated guideline from the European Society of Anesthesiology (ESA) was published, using GRADE and searching until May 2016 [30]. This CPG addressed two main clinical questions in order to help each anesthesiologists in their daily practice: 1. how should a pre-operative consultation clinic be organized and 2.…”

Biomarker-Based Preoperative Risk Stratification for Patients Undergoing Non-Cardiac Surgery

“…In contrast, patients with high functional capacity are at low risk for adverse cardiac events and can undergo surgery. However, further work-up is mandatory in all patients suffering from angina [8,9].…”

“…Newer biomarkers are under investigation [13,14]. However, cardiac biomarkers are of marginal importance in the American [8] and European [9] guidelines for perioperative risk assessment.…”