I’ll be discussing the 2024 ACC Periop Cardiac Guidelines at the 20th Annual Mid-Atlantic Hosp Med Conference at Mount Sinai (NYC) on Oct 24th. Looking forward to seeing my NY colleagues. ⁦@NewYorkACP⁩ ⁦@SocietyHospMed⁩

Nothing new. We know some level of hypotension for some amount of time is associated with AKI. Enough already. Assoc of intraop hypotension & acute kidney injury in noncardiac surgery pts:a post hoc secondary analysis of the EU HYPROTECT registry - PubMed

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Study finding that Pts with drug-gene interactions (DGIs) at the time of vascular surgery have incr risk of CV morbidity, incr readmission, & longer LOS. Drug-Gene Interactions & Clinical Outcomes After Vasc Surg in the Million Veteran Program

Recommendations from POQI for goal directed hemodynamic therapy (GDHT). Perioperative Quality Initiative consensus statement on goal-directed haemodynamic therapy

From MET-REPAIR: Confirms association of stable chronic HF with 30-d MACE, mortality, & postop complications - also incr risk with HFrEF. Outcomes in patients with chronic heart failure undergoing non‐cardiac surgery: a secondary analysis of the METREPAIR

Nice review of oral DM meds preop. However, it doesn’t include #SPAQI recommendations. My Simple recs: hold all on AM of surg;longer for SGLT2s. Managing noninsulin glucose-lowering medications before surgery: A comparison of clinical practice guidelines

Just gave medical grand rounds at my old stomping ground (SUNY Downstate). Nice to reconnect with some of my former residents (including current department chair Dr Salifu holding my new book) and other colleagues. Over 200 attendees!

In pts >65y/o, postop delirium had 3.5-fold higher odds of death or major complications, 2.8-fold higher odds of death, & 4.0-fold higher odds of nonhome discharge. There was substantial variation among hospitals.

AUB-HAS2 score may be more effective than RCRI in predicting CV events in patients with ESRD undergoing surgery - but ROC 0.68 vs 0.62 are not the best numbers.

Commentary on recent ABIM article

Just want to let my periop colleagues know about the Perioperative Care Congress Nov 7-9, 2025. A number of periop experts will be presenting research studies & discussing hot topics including tranexamic acid, ivabradine, MINS, & others. Here is the link:.

Interesting subanalysis of STOP-OR-NOT found preop CV risk (RCRI,AUB-HAS2,preop syst BP) did not affect pt outcomes with respect to continuing vs discontinuing RASi before major NCS.

Among adult patients undergoing noncardiac surgery, RIPC did not reduce myocardial injury or other postoperative complications. Effect of Remote Ischemic Preconditioning on Myocardial Injury in Noncardiac Surgery: the PRINCE Randomized Clinica…

Both risk calculators predicted death/MI/CVA in ESRD pts undergoing NCS but AUB-HAS2 was better than RCRI. Composite outcomes high: >11%.Comparing RCRI and AUB-HAS2 in ESRD Patients Undergoing Non-Cardiac Surgery, a retrospective Analysis of the Nation…

From VISION: 41 variable model to predict clin important postop hypoension is not practical. The 4 factor model- high-risk surg, open surg, preop syst BP<130, preop HR>100 seems overly simplistic (C-statistic .68 vs .72 for full model).

For anyone considering prophylactic CEA (vs med Rx alone) - Don't do it. Optimised medical therapy alone versus optimised medical therapy plus revascularisation for asymptomatic or low-to-…

RT @KurtPfeifer: Multidisciplinary preop meetings result in 32% of pts NOT having surgery. Characteristics and outcome of preoperative mult….

Factors associated with 30d mortality after periop CVA incl age, BMI, postop complications, CVA closer to surgery & periop blood transfusion-most are non-modifiable (exc anemia) .Factors associated with adverse outcomes following periop stroke after NCS

RT @rolandgarros: Carlos Alcaraz won this final. #RolandGarros

For POAF, as expected, a rhythm control strategy was associated with greater success rates for conversion to NSR vs rate control or no treatment strategy-no diff in mortality or LOS.