Before surgery, thorough screening for cardiovascular risk factors, associated comorbidities crucial

March 1, 2010

Dermatologic surgery patients who have some form of cardiovascular (CV) disease or components of metabolic syndrome may be at a higher risk for perioperative complications. Therefore, a careful screening of risk factors in all patients prior to their surgical procedures is warranted in order to help avoid unwanted adverse events and ensure the highest standard of care.

Key Points

Therefore, a careful screening of risk factors in all patients prior to their surgical procedures is warranted in order to help avoid unwanted adverse events and ensure the highest standard of care.

"Dermatologic surgeons should be more vigilant of the risk factors and the sometimes-subtle symptoms of CV disease in their patients, particularly when a surgery is planned," says Suzan Obagi, M.D., associate professor of dermatology and director of the Cosmetic Surgery and Skin Health Center at the University of Pittsburgh Medical Center, Sewickley, Pa.

Cardiovascular disease is very common, seen in about 35 percent of American adults. Patients can have an increased risk of clotting as well as fibrinogen abnormalities and plasminogen activator inhibitor abnormalities, all of which can negatively impact dermatologic surgical outcomes.

Adding fuel to the fire, patients may also have components of metabolic syndrome, including obesity, type 2 diabetes, insulin resistance, dyslipidemia and hypertension. These factors can further complicate the clinical picture.

High blood pressure

High blood pressure is considered by many as the most important indicator of a risk factor, and can be an absolute contraindication to proceeding with surgery.

The physician should check and monitor blood pressure, making sure that it is under control - especially on the day of the surgical intervention.

"We check pressures prior to an invasive procedure or any procedure where the patient will receive sedation or a lot of anesthesia," says Jeffrey Dover, M.D., F.R.C.P.C., associate clinical professor of dermatology at Yale School of Medicine and director at SkinCare Physicians, Chestnut Hill, Mass. "If the pressure is not controlled, we cancel the procedure and refer the patient back to their primary care physician or their cardiologist to get the pressure under better control and reschedule the surgery."

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