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Effect of the Gupta Score on Pre-operative Cardiology Consultation Requests in Noncardiac Nonvascular Surgery
Funda Atar1, Fatma Özkan Sipahioğlu1, Gülsen Keskin1
1University of Health Sciences Turkey, Etlik City Hospital, Clinic of Anaesthesiology and Reanimation, Ankara, Turkey.
Insights
The Gupta scale can reduce unnecessary cardiology consultations and diagnostic testing in preoperative evaluations. This approach may decrease surgical delays, intensive care unit stays, and overall healthcare costs.
Area of Science:
- Cardiology
- Anesthesiology
- Health Services Research
Background:
- Cardiology consultations are frequently required for pre-operative evaluations.
- Unnecessary consultations increase workload, delay surgeries, and incur additional costs.
- The Gupta scale offers a potential solution to optimize pre-operative cardiac risk assessment.
Purpose of the Study:
- To evaluate the impact of the Gupta scale on preoperative cardiology consultations and resource utilization.
- To compare surgical delays, major adverse cardiac events (MACE), and costs between patients evaluated with and without the Gupta scale.
Main Methods:
- Prospective study of 898 patients undergoing elective noncardiac, nonvascular surgery.
- Group I: Standard pre-operative assessment without a specific risk index.
- Group II: Pre-operative assessment utilizing the Gupta scale.
Main Results:
- The Gupta scale group significantly reduced cardiology consultations (P<0.001) and diagnostic testing (21.9% vs 8.75%).
- Intensive care unit (ICU) stay was significantly shorter in the Gupta group (P=0.019).
- Costs were significantly lower in the Gupta group (P=0.019), with a trend towards fewer MACE (3.08% vs 2.19%, P=0.076).
Conclusions:
- The Gupta scale effectively reduces unnecessary pre-operative cardiology consultations and diagnostic testing.
- Implementing the Gupta scale can lead to decreased surgical delays, ICU admissions, and healthcare expenditures.
- The Gupta scale shows promise in optimizing pre-operative patient management and resource allocation.
Objective:
Cardiologists are the most frequently consulted specialists during pre-operative evaluations. However, unnecessary cardiology consultations (CC) can increase cardiologists' workload without impacting anaesthesia practice, resulting in delayed surgeries and additional financial burdens. We hypothesize that using Gupta during the preoperative period can reduce these adverse effects.
Methods:
This prospective study included patients scheduled for elective noncardiac, nonvascular surgeries who underwent pre-operative assessment. Patients who had no specific risk index used for preoperative cardiac risk evaluation were classified as Group I, and those evaluated using the Gupta scale were classified as Group II. The study compared preoperative CC, diagnostic tests, surgical delays, major adverse cardiac event (MACE), length of hospital stay and intensive care unit (ICU) stay, mortality, and costs.
Results:
A total of 898 patients were included in the study, with 487 in Group I and 411 in Group II. The Gupta group reduced the demand for preoperative CC (P<0.001) and preoperative non-invasive diagnostic testing (n = 107, 21.9% vs. n = 36, 8.75%). The time from the anaesthesiology outpatient clinic to surgery was 15 days in Group I and 14 days in Group II (P=0.132). The length of ICU stay was higher in Group I (P=0.019). MACE was 15 patients (3.08%) in Group I and 9 patients (2.19%) in Group II (P=0.076). The cost of patients in Group I was higher than that in Group II (P=0.019).
Conclusion:
Using Gupta in preoperative evaluation may reduce unnecessary preoperative resource usage, surgical delays, ICU hospitalization rates, additional costs, and mortality.
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