High cholesterol, also known as hyperlipidemia, is a condition where there is an excess of lipids in the bloodstream. This substance is necessary for building healthy cells and making hormones, but too much of the low-density lipoprotein (LDL) or “bad” cholesterol can cause problems. A total cholesterol level above 200 milligrams per deciliter (mg/dL) is generally considered high for adults. Elevated cholesterol complicates surgical procedures because it indicates an underlying risk to the body’s vascular system, requiring specialized management during the stressful perioperative period to ensure patient safety.
How High Cholesterol Increases Surgical Risk
The primary danger high cholesterol poses during surgery is its link to atherosclerosis, the buildup of plaque within the artery walls. This plaque accumulation narrows the blood vessels, reducing blood flow and increasing the risk of a sudden blockage. During surgery, the body experiences physiological stress due to anesthesia and fluid shifts.
This stress triggers a systemic inflammatory response that can destabilize existing atherosclerotic plaques. When a plaque ruptures, it causes an acute thrombotic event, leading to a myocardial infarction (MI) or a stroke. Patients with high cholesterol are also more susceptible to post-induction hypotension, a significant drop in blood pressure following general anesthesia. This instability increases the risk of the heart or brain tissue being deprived of necessary oxygen and nutrients.
High cholesterol can also negatively affect recovery from certain non-cardiac procedures. The overall physiological compromise associated with high cholesterol means the body has less reserve to handle the demands of surgery and the subsequent healing process.
Pre-Operative Risk Assessment and Testing
When a patient with high cholesterol needs surgery, the medical team focuses on a comprehensive cardiovascular risk assessment. The evaluation integrates the patient’s overall health, including conditions like diabetes or hypertension, with the expected stress of the planned procedure. High-risk operations, such as major vascular or intrathoracic procedures, place a greater strain on the heart than low-risk surgeries.
The assessment begins with a detailed history to evaluate the patient’s functional capacity—how well the heart can handle physical stress. Doctors use metrics like the ability to climb two flights of stairs or walk four blocks (four metabolic equivalents, or METs) to gauge this capacity. If a patient reports symptoms of chest pain or shortness of breath, or has a history of heart disease, further testing is ordered.
Common pre-operative tests include a resting electrocardiogram (EKG), which checks for signs of prior heart damage or electrical abnormalities. For patients with poor functional capacity or other risk factors, a stress test may be considered to see how the heart performs under strain. The results of these tests, combined with the lipid panel and other factors, estimate the patient’s individual risk of a major cardiac event during the perioperative period. Non-emergent surgery is delayed if an active, unstable cardiac condition is identified, allowing time for medical stabilization before the procedure.
Strategies for Minimizing Perioperative Complications
To mitigate identified risks, the surgical team implements management strategies before and after the operation. A major focus is the management of statin therapy, the most common medication used to treat high cholesterol. Current medical guidelines recommend that patients already taking statins continue the medication right up until and immediately after the surgery.
The continuation of statins is important because these drugs possess anti-inflammatory and plaque-stabilizing effects, independent of their cholesterol-lowering properties. Abruptly stopping statin medication increases the risk of adverse cardiovascular events following the procedure. In high-risk patients not currently on statins, the medical team may consider starting the therapy pre-operatively to gain the protective benefits.
Controlling co-existing conditions, such as high blood pressure and elevated blood sugar, is also important, as these factors compound the cardiovascular danger posed by high cholesterol. Open communication between the patient, the primary care physician, and the surgeon ensures that all medications are reviewed and managed appropriately during the perioperative period. Post-operative protocols emphasizing early and frequent mobility help prevent blood clots, such as deep vein thrombosis, which is a risk during prolonged immobility after surgery.