Analysis of perioperative management of patients with cardiovascular pathology before non-cardiac surgery

Authors

  • M.O. Harbar Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
  • U.A. Fesenko Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
  • Ya.M. Pidhirnyі Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
  • Y.O. Svitlyk Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
  • H.V. Svitlyk Danylo Halytsky Lviv National Medical University, Lviv, Ukraine

DOI:

https://doi.org/10.22141/2224-0586.16.6.2020.216513

Keywords:

perioperative risk, non-cardiac surgery, concomitant cardiac pathology

Abstract

Background. Optimal and well-grounded pre-operative assessment is an important tool for improving patients’ outcomes. Despite published guidelines by the European Societies of Cardio­logy and Anesthesiology (ESC, ESA) Ukrainian medicine has not routinely accepted the algorithm of modern pre-operative assessment. The purpose of our study was to analyze standards of current pre-operative cardiac assessment of adults undergoing elective non-cardiac surgery and identify aspects that can be improved for the benefit of a patient and the clinic. Materials and methods. We have examined 242 elective surgery cases and peculiarities of all pre-operative assessments and interventions taking into account patients’ characteristics and surgery type. Results. All patients underwent standard examinations according to the established rules. The ECG was recorded in all subjects, resting echocardiography was performed to 47 %, troponin test was in 3 %. According to ESC and ESA guidelines, functional capacity should be evaluated in 167 (69 %) individuals with further assessing clinical cardiac risk factors and non-invasive stress tests performing in persons with a high risk of myocardial infarction and cardiac death. Cardiac biomar­kers should be determined in 44 patients (18 %), resting ECG was registered to 127 patients (53 %) and resting echocardiography – to 38 people (16 %). Such tactics require communication between the outpatient and inpatient units of the medical system. Conclusions. Pre-operative evaluation of almost all patients takes place within 24–48 hours after hospitalization. Elective non-cardiac surgery patients don’t have sufficient time to implement interventions to improve outcomes. We don’t promote functional capacity assessment, risk-scales, non-invasive stress-tests, and biomarkers for predicting adverse outcomes. Ukraine has all resources to implement current Guidelines on pre-operative evaluation to an individual patient and hospital benefits.

References

Kristensen S.D., Knuuti J., Saraste A. et al. 2014 ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assessment and manage-ment: The Joint Task Force on non-cardiac surgery: cardiovascular assessment and management of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA). European Heart Journal. 2014. 35(35). 2383-2431. doi: 10.1093/eurheartj/ehu282.

De Hert S., Staender S., Fritsch G. et al. Pre-operative evaluation of adults undergoing elective noncardiac surgery: Updated guideline from the European Society of Anaesthesiology. European Journals of Anaesthesiology. 2018. 35(6). 407-465. doi: 10.1097/EJA.0000000000000817.

Revised cardiac risk index for pre-operative risk. https://www.mdcalc.com/revised-cardiac-risk-index-pre-operative-risk.

Gupta P.K., Gupta H., Sundaram A. et al. Development and validation of a risk calculator for prediction of cardiac risk after surgery. Cir-culation. 2011. 124(4). 381-387. doi: 10.1161/circulationaha.110.015701.

Biccard B.M. Relationship between the inability to climb two flights of stairs and outcome after major non-cardiac surgery: implications for the pre-operative assessment of functional capacity. Anaesthesia. 2005. 60(6). 588-593. doi: 10.1111/j.1365-2044.2005.04181.x/.

Bierle D.M., Raslau D., Regan D.W., Sundsted K.K., Mauck K.F. Preoperative evaluation before noncardiac surgery. Mayo Clinic Pro-ceedings. 2020. 95(4). 807-822. doi: 10.1016/j.mayocp.2019.04.029.

Devereaux P.J., Chan M.T., Alonso-Coello P. et al. Association between postoperative troponin levels and 30-day mortality among pa-tients undergoing noncardiac surgery. JAMA. 2012. 307(21). 2295-2304. doi: 10.1001/jama.2012.5502.

Duceppe E., Parlow J., MacDonald P. et al. Canadian cardiovascular society guidelines on perioperative cardiac risk assessment and management for patients who undergo noncardiac surgery. The Canadian journal of cardiology. 2017. 33(1). 17-32. doi: 10.1016/j.cjca.2016.09.008.

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Published

2020-09-01

Issue

Vol. 16 No. 6 (2020)

Section

Original Researches

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