Training general surgery residents to avoid postoperative cardiac events

Area of Science:

• Cardiology
• General Surgery
• Medical Decision Making

Background:

• Acquiring expertise in cardiac risk assessment is time-consuming.
• Unnecessary cardiology consultations can delay patient treatment and strain healthcare resources.

Purpose of the Study:

• To evaluate the effectiveness of specific criteria for general surgery residents in obtaining cardiology consultations.
• To determine if these criteria appropriately select patients requiring further cardiac work-up before surgery.

Main Methods:

• Retrospective review of cardiac work-up and postoperative events for general surgery patients over one year.
• General surgery residents (Postgraduate years 1-3) used defined criteria to request cardiology consultations.
• Criteria included: coronary intervention >2 years prior, current anti-anginal medication use, or symptomatic status/abnormal ECG, tempered by planned procedure.

Main Results:

• Of 720 screened patients, 37 (5%) received cardiology consultations; 97% met at least one criterion.
• Cardiac imaging was performed on 65% of referred patients, with 33% showing positive results.
• Thirty percent of referred patients did not proceed with surgery after risk minimization, and 15% declined; overall surgical mortality was 2% with no postoperative myocardial infarctions or cardiac deaths.

Conclusions:

• The established criteria effectively identify general surgery patients who require further cardiac evaluation.
• Cardiology consultations often lead to revised surgical risk-benefit assessments by surgeons and patients.