Possible Implications for Clinical Practice and Resource Use When Applying the 2022 ESC Guidelines for Perioperative...

Myocardial injury after non-cardiac surgery (MINS) is a significant postoperative complication. In 2022, the European Society of Cardiology (ESC) updated its guidelines, recommending perioperative troponin monitoring for a broader surgical population. This study aimed to assess the implications of implementing these guidelines in a secondary Swiss hospital.

Patients meeting ESC guideline criteria for troponin testing were identified, along with those undergoing surgeries deemed similar in risk and complexity. We retrospectively analyzed all in-patient non-cardiac surgeries performed in 2023 (n = 6413). Demographic data, cardiac risk factors, new cardiac diagnoses, and mortality within 3 months post-surgery were assessed. The primary outcome was the demand for postoperative troponin testing when applying the 2022 ESC guidelines. The secondary outcome was to detect new cardiac diagnoses among patients meeting these criteria.

Of the 6413 in-patient surgeries, 1306 (20%) met the guideline's or study-defined criteria for intermediate-risk, high-risk, or procedures similar regarding risk and complexity. After excluding ineligible patients, we analyzed data from 1231 patients, and found 1089 patients (88% of included patients; 17% of all patients) who would have required testing. Within 3 months postoperatively, we identified 72 patients (6%) who developed new cardiac conditions and 54 patients (4%) died. Surgeries outside regular hours comprised 17% of cases.

Substantial postoperative troponin testing would be required to comply with the 2022 ESC guidelines, necessitating expanded organizational capacity and resources. While the value of early detection and prevention of MINS is clear, implementation in routine clinical practice may be challenging.