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Perioperative cardiology: an inspiring arena for the Chameleon doctor
  1. Bruno Caramelli
  1. Correspondence to Professor Bruno Caramelli, Heart Institute (InCor), University of São Paulo, Av. Dr Eneas de Carvalho Aguiar 44, São Paulo 05403-000, Brazil; bcaramel{at}usp.br

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The estimated annual global volume of surgical procedures increased by 38% between 2005 and 2012, reaching 312.9 million.1 ,2 Taking into account both the world population of seven billion and the average life expectancy of 71 years, one can easily estimate that each individual would undergo surgery 3.2 times in a lifetime.3 Some surgeries are quite simple, but others are associated with an increased risk of complications and require more intensive care, including major surgeries or interventions in patients with comorbidities.4 Each intervention has its own risk of complications, depending on important constraints that are shown in figure 1.

Figure 1

Constraints related to the risk of perioperative complications.

Many algorithms have been elaborated for identification of patients more prone to developing cardiovascular complications after non-cardiac surgery in order to mitigate this risk.5 These clinical tools check for the presence of clinical and surgical variables summarised in figure 1 and create workflows that branch and merge, often leading to decision panels. At the end of each workflow, the physician obtains the risk of complications and a recommendation on how to avoid them. Nonetheless, these complications can occur in up to 25% of the …

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