Integrated Metabolic and Cardiovascular Optimization Before Surgery: Multidisciplinary Strategies to Reduce Perioperative Risk

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Abstract
Metabolic optimization before surgery has become an essential component of contemporary perioperative medicine due to the increasing prevalence of obesity, diabetes mellitus, hypertension, metabolic syndrome, dyslipidemia, and cardiovascular disease among adult surgical populations worldwide. The present review aimed to analyze the endocrine and cardiovascular factors influencing perioperative surgical risk and to evaluate the impact of preoperative metabolic optimization on postoperative outcomes and surgical safety. A comprehensive narrative review methodology based on the Scientific Method and a Process-Based Methodology was employed using scientific literature indexed in PubMed, Scopus, Cochrane Library, and international clinical guidelines. The review analyzed evidence related to perioperative glycemic control, cardiovascular assessment, obesity-associated surgical complications, endocrine dysfunction, inflammatory mechanisms, pharmacological management, and multidisciplinary perioperative care models. The findings demonstrated that poor metabolic control is strongly associated with increased postoperative infection, cardiovascular instability, delayed wound healing, prolonged hospitalization, thromboembolic events, and intensive care admission. Hyperglycemia, insulin resistance, endothelial dysfunction, oxidative stress, systemic inflammation, and neurohormonal activation were identified as major mechanisms contributing to perioperative morbidity. Multidisciplinary optimization strategies integrating surgery, endocrinology, cardiology, anesthesiology, nutrition, and internal medicine consistently improved perioperative outcomes and reduced preventable complications. Additionally, the review highlighted the growing perioperative relevance of modern cardiometabolic therapies such as GLP-1 receptor agonists and SGLT2 inhibitors. The evidence supports the conclusion that structured preoperative metabolic and cardiovascular optimization significantly improves surgical safety and postoperative recovery in adult patients with cardiometabolic disease, particularly within healthcare systems experiencing increasing burdens of obesity and diabetes mellitus, including Mexico, Colombia, and Ecuador.