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Elective Inguinal Hernia Surgery in the Setting of Unfollowed Congenital Complete Heart Block With No Postponement
Kyle S Varkoly1, Roxana Beladi2, Steven Ritrosky3
1Cardiology, Kansas City University of Medicine and Biosciences, Joplin, USA.
Insights
A proactive anesthesiologist safely prevented elective surgery delay in a patient with congenital third-degree heart block, demonstrating risk stratification and guideline adherence for similar cases.
Area of Science:
- Anesthesiology
- Cardiology
- Medical Case Reports
Background:
- Complete heart block often leads to elective surgery deferral pending cardiology evaluation.
- Surgical delays increase healthcare costs, disease severity, and patient dissatisfaction.
- Congenital heart block requires careful preoperative risk assessment.
Observation:
- A case of an asymptomatic patient with unfollowed congenital third-degree heart block requiring elective inguinal hernia repair.
- Standard practice involves delaying surgery for cardiology clearance.
- A proactive anesthesiologist managed the patient without delay.
Findings:
- The anesthesiologist utilized established guidelines for non-elective noncardiac surgery to assess and manage the patient.
- Preoperative and intraoperative measures were implemented to ensure patient safety.
- The elective surgery proceeded without delay.
Implications:
- This case demonstrates a precedent for safely managing elective surgeries in patients with unfollowed congenital heart block.
- Proactive risk stratification by anesthesiologists can prevent unnecessary surgical delays.
- Adherence to established guidelines can optimize patient outcomes and resource utilization.
Abstract:
Most preoperatively discovered complete heart block cases without cardiac clearance in a non-emergent situation are managed with deferral of elective surgery until a cardiology workup can be completed. The medical consequences of surgical delays can manifest in increased costs to the healthcare system via the treatment of more advanced disease, often requiring more intense and more costly treatment in addition to the emotional burden of delay on a patient that has been waiting months for a particular surgery. Delays in surgery have real impacts on patient health outcomes, hospital finances, and patient satisfaction. We present a rare case in which a proactive anesthesiologist was able to take measures to stratify patient safety risk and safely prevent the delay of the surgery in an asymptomatic and unfollowed congenital third-degree heart block patient. The anesthesiologist demonstrates the use of established guidelines for non-elective noncardiac surgery to safely and effectively prevent the delay of an elective inguinal hernia repair in the setting of a situation that normally warrants its delay. Using these pre- and intraoperative measures, the anesthesiologist was able to prevent the delay of elective surgery, and this should set a precedent of the necessary steps involved to safely manage a patient with an unfollowed third-degree congenital heart block.
