Priority 3 from the Heart Surgery PSP

UNCERTAINTY: How can we improve the outcomes of heart surgery patients with chronic conditions (obesity, diabetes, hypertension, renal failure, auto-immune diseases etc)? (JLA PSP Priority 3)
Overall ranking 3
JLA question ID 0088/3
Explanatory note Specific chronic conditions are taken into account in current evidence-based recommendations and investigated in systematic reviews (e.g. general advisory statements for obese patients undergoing surgery or more specific procedural recommendation like the skeletonized internal mammary artery harvesting in obese and/or diabetic patients to reduce the risk of wound infection, perioperative arterial pressure and glycaemic optimization, pharmacological and non-pharmacological interventions to protect kidneys; auto-immune diseases have been less thoroughly examined, still forms of vasculitis constitute a chapter in the ESC guidelines on aortic diseases. However, despite the abundancy of literature output on these themes, the broadness of the question and gaps still present in the evidence would probably advice for further research.
~ Does management of patients' co-morbidities like hypertension, diabetes change the risk profile in major cardiovascular surgery/anaesthesia? Does having an autoimmune disease increase the risk of complications during cardiac surgery? Does preoperative anaemia affect outcome from heart surgery? Effect of diabetes on outcomes of cardiac surgery? Effect of obesity on outcomes of cardiac surgery? 
Evidence

Sousa-Uva M, Head SJ, Milojevic M, Collet JP, Landoni G, Castella M, et al. 2017 EACTS Guidelines on perioperative medication in adult cardiac surgery. Eur J Cardiothorac Surg. 2018;53(1):5-33; Zacharias M, Mugawar M, Herbison GP, Walker RJ, Hovhannisyan K, Sivalingam P, et al. Interventions for protecting renal function in the perioperative period. Cochrane Database of Systematic Reviews. 2013(9). Poirier P, Alpert MA, Fleisher LA, Thompson PD, Sugerman HJ, Burke LE, et al. Cardiovascular evaluation and management of severely obese patients undergoing surgery: a science advisory from the American Heart Association. Circulation. 2009;120(1):86-95.
Health Research Classification System category Cardiovascular
Extra information provided by this PSP
Original uncertainty examples If co-morbidities (hypertension, diabetes) are well managed long term by the patient, does it change the risk profile in major cardiovascular surgery/anaesthesia? ~ Does having an autoimmune disease increase the risk of complications during cardiac surgery? ~ Does preoperative anaemia affect outcome from heart surgery? ~ Effect of obesity on outcomes of cardiac surgery? ~ Effect of diabetes on outcomes of cardiac surgery? 
Submitted by 2 x patient, 2 x carer, 12 x healthcare professional, 2 x others 
PSP information
PSP unique ID 0088
PSP name Heart Surgery
Total number of uncertainties identified by this PSP. 45  (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop 11 July 2019