Asymptomatic preoperative hypertension in elective surgery
Was reading an overview of a closed-claim case and one of the arguments prosecution made was that since the patients preoperative SBP was greater than 180 the case should’ve been canceled. This was an elective surgery in a hospital setting. While the actual event was not related to hemodynamics, the anesthesiologist was ultimately found partially liable anyway.
The somewhat arbitrary cutoff (asymptomatic SBP>180, DBP>110) for cancelling elective case that I was taught in residency is almost never practiced in my experience. I work in a very busy community hospital, conservatively we’d be canceling 15+ cases per day if this was followed.
My question to the community: For patients undergoing elective surgery in a hospital setting, who took their home antihypertensive as directed, presenting with asymptomatic hypertension by the definition above… how are you proceeding? And (potentially more importantly) what is the culture at your institution, how do your colleagues and surgeons act in this case?
- do you cancel outright?
- do you pretreat and proceed, or pretreat and wait for response?
- does the actual case make a difference in your decision ie: TCAR, TSR in beach chair, MAC case? Or is everyone getting treated the same?
- does the fact that they had a recent clinic visit where they had a normal blood pressure make you more wary? What if their preop visit had them at 170/100?
Nobody at my institution feels like the asymptomatic hypertensive patient is a hill we’re all gonna start dying on, but I wonder if this is maybe the wrong take?