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Cardiac assessment prior to non-cardiac surgery
J F Mooney1,2, G S Hillis1, V W Lee3
1The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia.
Insights
Preoperative cardiac risk assessment for non-cardiac surgery is inconsistent. High-risk patients are under-investigated, while low-risk patients are over-investigated, suggesting a need for systematic evaluation to improve outcomes and reduce costs.
Area of Science:
- Cardiology
- Anesthesiology
- Perioperative Medicine
Background:
- Older patients with comorbidities undergoing non-cardiac surgery present challenges in preoperative cardiac assessment.
- Current preoperative cardiac assessment practices are often unsystematic and vary widely.
- There is a need to evaluate if high-risk patients receive adequate assessment and low-risk patients are not over-investigated.
Purpose of the Study:
- To compare the utilization of cardiac investigations in patients stratified by preoperative cardiac risk before non-cardiac surgery.
- To identify disparities in cardiac assessment between high-risk and low-risk surgical patients.
Main Methods:
- A representative sample of patients undergoing elective non-cardiac surgery was analyzed.
- Preoperative cardiac risk was determined using the Revised Cardiac Risk Index.
- Cardiac assessment patterns were examined in relation to patient risk stratification.
Main Results:
- Out of 671 patients, 12% were classified as high-risk and 88% as low-risk.
- Nearly 45% of high-risk patients and 14% of low-risk patients underwent investigations for coronary ischemia.
- High-risk patients with coronary disease were undertreated with beta-blockers (46%), aspirin (49%), and statins (77%).
Conclusions:
- Preoperative cardiac investigation patterns are inconsistent across surgical subspecialties.
- Low-risk patients tend to be over-investigated, while high-risk patients are under-investigated.
- A systematic approach to cardiac risk assessment could enhance clinical outcomes, reduce healthcare costs, and improve efficiency.
Background:
Increasingly, patients undergoing non-cardiac surgery are older and have more comorbidities yet preoperative cardiac assessment appears haphazard and unsystematic. We hypothesised that patients at high cardiac risk were not receiving adequate cardiac assessment, and patients with low-cardiac risk were being over-investigated.
Aims:
To compare in a representative sample of patients undergoing non-cardiac surgery the use of cardiac investigations in patients at high and low preoperative cardiac risk.
Methods:
We examined cardiac assessment patterns prior to elective non-cardiac surgery in a representative sample of patients. Cardiac risk was calculated using the Revised Cardiac Risk Index.
Results:
Of 671 patients, 589 (88%) were low risk and 82 (12%) were high risk. We found that nearly 14% of low-risk and 45% of high-risk patients had investigations for coronary ischaemia prior to surgery. Vascular surgery had the highest rate of investigation (38%) and thoracic patients the lowest rate (14%). Whilst 78% of high-risk patients had coronary disease, only 46% were on beta-blockers, 49% on aspirin and 77% on statins. For current smokers (17.3% of cohort, n = 98), 60% were advised to quit pre-op.
Conclusions:
Practice patterns varied across surgical sub-types with low-risk patients tending to be over-investigated and high-risk patients under-investigated. A more systemised approach to this large group of patients could improve clinical outcomes, and more judicious use of investigations could lower healthcare costs and increase efficiency in managing this cohort.
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