Impact of Preoperative Cardiac Evaluation and Recommendations on Morbidity and Mortality in Patients Undergoing...

Preoperative cardiac evaluation aims to reduce cardiovascular risks in elective non-cardiac surgery, however its routine use is a subject of ongoing debate due to low event rates. This study examines patient characteristics, risk factors, diagnostic findings, recommendations, and outcomes to assess the value of these consultations and refine referral criteria.

This retrospective cohort study included 482 patients who underwent elective non-cardiac surgery with preoperative cardiology consultations at a tertiary hospital (March-September 2021). Data on demographics, cardiovascular risks, echocardiographic/electrocardiographic findings, recommendations, and outcomes (in-hospital complications, mortality, one-year survival, hospital stay) were analyzed.

The median age of the patients was 69 years (interquartile range [IQR] 60-76), and 66.2% were male. Common surgeries included endoscopy/colonoscopy (31.7%) and genitourinary procedures (19.3%). Coronary artery disease (48.8%), hypertension (48.9%), and diabetes (37.8%) were prevalent. Most cases (96.5%) were asymptomatic, with ejection fractions > 50% (88.1%). Common recommendations included antiplatelet/anticoagulant modification (41.1%), although 54.8% of patients required no new recommendations. New diagnoses were rare (3.7%). In-hospital complications occurred in 2.9%, mortality in 0.6%, and one-year mortality in 1.7% of the patients, with a median hospital stay of 1 day (IQR 0-3).

Despite the high burden of comorbidities in the study cohort, low adverse event rates suggest many consultations may be unnecessary, particularly in asymptomatic patients with preserved function, supporting more selective referral criteria to enhance efficiency.