Preoperative advanced cardiology evaluation in adult non-cardiac surgery: A retrospective cohort study
Preoperative cardiac evaluation in non-cardiac surgery
Keywords:cardiac patient, perioperative risk, preoperative evaluation, cardiology consultation
Background/Aim: Advanced cardiology evaluation (ACE) is the most frequently requested consultation during preoperative medical evaluations (PMEs) performed in anesthesia outpatient clinics. However, the efficacy and results of this ACE request are unclear. We aimed to show the frequency of ACE requested during PME of patients undergoing non-cardiac surgery (NCS) and its effect on diagnosis, treatment process, and surgical time planning.
Methods: This is a single-center, retrospective cohort study of 300 patients aged 18 years and older who need ACE. Medical charts were reviewed for patient characteristics and diagnosis, planned surgery type, surgical intervention risk, revised cardiac risk index (RCRI), other consultation records, cardiology consultation indication, risk group determined by the cardiologist, metabolic equivalent (METs), and anticoagulant use were recorded.
Results: We analyzed the data of 300 patients for whom ACE was requested from 9825 patients who underwent PME. The mean age was 66 (12) years, and the most common age range was 60–79 years (62.7%). The proportion of patients with METs ≤4 was 11% (n=33). The most common additional consultation was chest disease (10%), and the most common co-morbidity was hypertension (61.6%). The most common reason for consultation was a history of ischemic heart disease (50%). According to the revised cardiac risk index, most patients were in class 2, while according to the cardiology consultation outcome grade, most patients were in the intermediate risk group. It was observed that the cardiology consultation process was mostly completed on the same day (255 patients, 85%), and the use of anticoagulant drugs was mostly left to the individual evaluation of the surgeon (143 patients, 47.7%).
Conclusion: PME should be given due care to prevent perioperative cardiac complications in patients undergoing NCS. More careful patient assessments are needed during ACEs. This would allow for more accurate risk stratifications and, if necessary, the ordering of additional testing.
Gündüz E, Coşkun FN, Arıcı G, Akbaş M. Effectiveness of preoperative cardiac assessment methods in patients with non-heart surgery. Akdeniz Med J. 2019;119(1):92–9. DOI: https://doi.org/10.17954/amj.2019.1969
Groot MW, Spronk A, Hoeks SE, Stolker RJ, Van Lier F. The preoperative cardiology consultation: Indications and risk modification. Netherlands Hear J. 2017;25(11):629–33. DOI: https://doi.org/10.1007/s12471-017-1004-1
Yıldız ŞB, Gürsoy MO. Kalp dışı cerrahi girişim uygulanacak kalp hastalarında preoperatif değerlendirme. Koşuyolu Hear J. 2015;18(1):39–44. DOI: https://doi.org/10.5578/khj.5303
Lee TH, Marcantonio ER, Mangione CM, Thomas EJ, Carisi A, Cook EF, et al. Prediction of cardiac risk of major non-cardiac surgery. Circulation. 1999;100(10):1043-9. DOI: https://doi.org/10.1161/01.CIR.100.10.1043
Zambouri A. Preoperative evaluation and preparation for anesthesia and surgery. Hippokratia. 2007;11(1):13–21.
Preoperative Evaluation (2015). Turkish Society of Anesthesiology and Reanimation Anesthesia Practice Guidelines. https://www.tard.org.tr/assets/kilavuz/preoperatifdegerlendirme.
Hulme RA, Forssten MP, Pourlotfi A, Cao Y, Bass GA, Matthiessen P, et al. The Association Between Revised Cardiac Risk Index and Postoperative Mortality Following Elective Colon Cancer Surgery: A Retrospective Nationwide Cohort Study. Scand J Surg. 2022;111(1):14-21. DOI: https://doi.org/10.1177/14574969211037588
Doğu H, Doğu D. Nonkardiyak preicerrahi uygulanacak kardiyak hastalardaki peri operatif risk faktörlerinin belirlenmesi. Kartal Eğit ve Araşt Hast Tıp Derg. 2001;12(3):120-5.
Naughton C, Feneck RO. The impact of age on 6-month survival in patients with cardiovascular risk factors undergoing elective non-cardiac surgery. Int J Clin Pract. 2007;61(5):768-76. DOI: https://doi.org/10.1111/j.1742-1241.2007.01304.x
Carroll K, Majeed A, Firth C, Gray J. Prevalence and management of coronary heart disease in primary care : population-based cross-sectional study using a disease register. J Public Health Med. 2003;25(1):29-35. DOI: https://doi.org/10.1093/pubmed/fdg007
Katz RI, Cimino L, Vitkun SA. Preoperative medical consultations: impact on perioperative management and surgical outcome. Can J Anaesth. 2005;52(7):697-702. DOI: https://doi.org/10.1007/BF03016556
Poldermans D, Bax JJ, Boersma E, De Hert S, Eeckhout E, Fowkes G, et al. Guidelines for preoperative cardiac risk assessment and perioperative cardiac management in non-cardiac surgery: the Task Force for Preoperative Cardiac Risk Assessment and Perioperative Cardiac Management in Non-cardiac Surgery of the European Society of Cardiology (ESC) and endorsed by the European Society of Anaesthesiology (ESA). Eur J Anaesthesiol. 2010;27(2):92-137. DOI: https://doi.org/10.1097/EJA.0b013e328334c017
Maggio C, Bonzano A, Conte E, Libertucci D, Panarelli M, Bobbio M, et al. Preoperative evaluation in non-cardiac surgery: Cardiac risk assessment. Int J Qual Heal Care. 1992;4(3):217–24. DOI: https://doi.org/10.1093/oxfordjournals.intqhc.a036722
Gündüz E. Kalp dışı cerrahi̇de kardi̇yak hastaların preoperati̇f değerlendi̇ri̇lmesi̇ [dissertation]. Akdeniz University Faculty of Medicine, Antalya; 2011.
Mendes DA, Silva da I, Ramires V, Reichert F, Martins R, Ferreira R, et al. Metabolic equivalent of task (METs) thresholds as an indicator of physical activity intensity. PLoS One. 2018;13(7):1–10. DOI: https://doi.org/10.1371/journal.pone.0200701
Fleisher LA, Fleischmann KE, Auerbach AD, Barnason SA, Beckman JA, Bozkurt B, et al. Perioperative beta blockade in non-cardiac surgery: a systematic review for the 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing non-cardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines. Circulation. 2014;130(24):278-333. DOI: https://doi.org/10.1161/CIR.0000000000000104
Santangelo G, Faggiano A, Toriello F, Carugo S, Natalini G, Bursi F, et al. Risk of cardiovascular complications during non-cardiac surgery and preoperative cardiac evaluation. Trends Cardiovasc Med. 2022;32(5):271-84. DOI: https://doi.org/10.1016/j.tcm.2021.06.003
- 52 61
How to Cite
Copyright (c) 2023 Fatih Şimşek, Ela Erten
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.