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Preoperative cardiac evaluation and management of patients undergoing elective non-cardiac surgery

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In the 2010–11 financial year, 2.4 million surgical operations were performed in Australian hospitals, most (80%) being elective non-cardiac surgery.1 Cardiac complications — myocardial infarction (MI), cardiac arrest and other serious arrhythmias, and acute heart failure — occur in about 5% of patients aged 70 years or older undergoing non-cardiac surgery.2,3 Such complications carry 30-day mortality rates between 15% and 20% and account for a third of all postoperative deaths.2,3 They also prolong hospital length of stay, increase illness burden and reduce long-term survival.4,5 Some are potentially preventable: the Australian Incident Monitoring Study found that 3.1% of adverse events in hospital resulted from inadequate or incorrect preoperative assessment or preparation of patients.6 Inadequate preoperative assessment and medical optimisation of patients also causes delays or cancellations in surgery.