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A survey of methods used for cardiac risk assessment prior to major vascular surgery
J A Michaels1, S P Payne, R B Galland
1Department of Surgery, Royal Berkshire Hospital, Reading, U.K.
Insights
Vascular surgeons show varied cardiac risk assessment practices before major surgery. Those performing more procedures are more aggressive in assessing cardiac risk in high-risk patients.
Area of Science:
- Cardiology
- Vascular Surgery
- Clinical Risk Assessment
Background:
- Pre-operative cardiac risk assessment is crucial for patients undergoing major vascular surgery.
- Current practices among vascular surgeons regarding cardiac risk assessment and management of high-risk patients require evaluation.
Purpose of the Study:
- To determine the frequency of various cardiac risk assessment methods used before major vascular surgery.
- To understand how high-risk patients are managed by vascular surgeons.
Main Methods:
- A questionnaire survey was distributed to vascular surgeons in Great Britain and Northern Ireland.
- Data collected focused on the routine or frequent use of specific investigations and management strategies.
Main Results:
- Ejection fraction assessment was the most common cardiac investigation used.
- Access to high dependency units and intensive therapy units was common post-aortic reconstruction.
- Clinical risk indices were rarely employed, while referral to cardiologists was frequent for high-risk patients.
Conclusions:
- Significant variability exists in cardiac risk assessment practices among vascular surgeons.
- Surgeons performing a higher volume of vascular procedures tend to be more proactive in cardiac risk assessment.
Objectives:
To assess the frequency with which various methods of cardiac risk assessment are used prior to major vascular surgery and the way in which patients considered to the "high" risk are managed.
Design:
Questionnaire survey.
Setting:
Great Britain and Northern Ireland.
Materials:
Vascular Surgeons who are current members of the Vascular Surgical Society of Great Britain and Northern Ireland.
Chief Outcome Measures:
Number of respondents reporting routine or frequent use of particular investigations and methods of management.
Main Results:
Of 246 respondents, 52% had access to a high dependency unit and 77% used intensive therapy units routinely following aortic reconstruction. Some measure of ejection fraction was the most common investigation and was used routinely prior to aortic reconstruction by 35% and often by 33% of respondents, this being more frequent in respondents from teaching hospitals and those carrying out a greater number of reconstructions. Calculated clinical risk indices were rarely used. The identification of high risk patients led to referral to a cardiologist for 90% of respondents and influenced the choice of anaesthetist for 50%.
Conclusions:
It is concluded that there is considerable variation in practice, but that those who carry out more vascular surgery are more aggressive in their assessment of cardiac risk prior to reconstruction.