Perioperative mortality from all causes with 48 hours of anesthetic care in the United States is approximately 1/500 (0.2 percent). If one extends the perioperative period out to 30 days after anesthetic care, that number increases 10-fold to roughly 2 percent.2,3 If the 30-day interval after surgery were considered a disease, it would be the third-leading cause of death in the U.S.

In a large international study, 8 percent of patients >age 45sustain a post-operative myocardial injury, as defined by a troponin elevation that appears to be of ischemic origin, but only 42 percent meet criteria to be called a myocardial infarction (MI).3-5 Sixty-five percent are clinically silent, undetectable without biomarker testing. Nonetheless – silent or notmortality is nearly identical. These are the same patients we have...

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