On December 8, Venezuelan President Hugo Chavez announced his immediate return to Havana for a fourth round of cancer surgery.

Chavez’s emergency return to Cuba for a fresh operation, the latest round of treatments there, and increasingly infrequent public appearances have left Venezuelans wondering who will be in charge of their nation in 2013 and beyond.

Unlike before, Chavez spoke emotionally this time about a possible succession, naming Vice President and Foreign Minister (since 2006) Nicolas Maduro as the chosen leader of the Venezuelan Socialist Party and urging his followers to vote for Maduro if something were to occur: “You choose Maduro as president of the republic. I am asking you this from all my heart.”

Following the October 7 presidential elections, Chavez elevated the loyal Maduro, a former bus driver and union organizer, to the vice presidency. Maduro, who reportedly received training in Cuba, is believed to have the backing of the Castro regime.

Chavez’s return to Cuba for surgery clearly raises a possibility that he will either be unable to take the presidential oath on January 10 or be unable to exercise power in the coming six years, which would bring an end to Chavez’s 13-year reign.

According to Venezuela’s constitution, new presidential elections must take place within 30 days of the death or resignation of the president.

For nearly two years, Chavez’s illness has been handled in a classically authoritarian manner—shrouded in denials and false assertions and laced with behind-the-scenes jockeying for power.

Chavez’s illness draws attention away from elections on December 16, when Venezuelans select 23 state governors and regional legislatures. The opposition hopes to retain a sense of unity and political visibility while the ailing Chavez and his backers are striving for ever greater political dominance. Chavez is using the state elections to secure elective office for some of his closest colleagues such as former Vice President Elias Jaua (Miranda state) and former Minister of Defense and U.S.-designated “drug kingpin” General Henry Rangel Silva (Trujillo state).

The regime’s objective is a perpetuation of Chavismo (populism, authoritarianism, nationalism, and anti-Americanism) without Chavez.

The chances that 2013 will see a Venezuela racked by uncertainty at the top just increased dramatically. As a major supplier of oil to the U.S. and linchpin for anti-Americanism in the Western Hemisphere, Venezuela, its future, and Chavez’s absence (temporary or permanent) is a matter of considerable importance to U.S interests throughout the region.