Analysis of perioperative management of patients with cardiovascular pathology before non-cardiac surgery
Keywords:perioperative risk, non-cardiac surgery, concomitant cardiac pathology
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.
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.
Copyright (c) 2020 EMERGENCY MEDICINE
This work is licensed under a Creative Commons Attribution 4.0 International License.
Our edition uses the copyright terms of Creative Commons for open access journals.
Authors, who are published in this journal, agree with the following terms:
- The authors retain rights for authorship of their article and grant to the edition the right of first publication of the article on a Creative Commons Attribution 4.0 International License, which allows others to freely distribute the published article, with the obligatory reference to the authors of original works and original publication in this journal.
- Directing the article for the publication to the editorial board (publisher), the author agrees with transmitting of rights for the protection and using the article, including parts of the article, which are protected by the copyrights, such as the author’s photo, pictures, charts, tables, etc., including the reproduction in the media and the Internet; for distributing; for the translation of the manuscript in all languages; for export and import of the publications copies of the writers’ article to spread, bringing to the general information.
- The rights mentioned above authors transfer to the edition (publisher) for the unlimited period of validity and on the territory of all countries of the world.
- The authors guarantee that they have exclusive rights for using of the article, which they have sent to the edition (publisher). The edition (the publisher) is not responsible for the violation of given guarantees by the authors to the third parties.
- The authors have the right to conclude separate supplement agreements that relate to non-exclusive distribution of their article in the form in which it had been published in the journal (for example, to upload the work to the online storage of the journal or publish it as part of a monograph), provided that the reference to the first publication of the work in this journal is included.
- The policy of the journal permits and encourages the publication of the article in the Internet (in institutional repository or on a personal website) by the authors, because it contributes to productive scientific discussion and a positive effect on efficiency and dynamics of the citation of the article.
- The rights to the article are deemed transferred by the authors to the edition (the publisher) since the moment of the publication of the article in the printed or electronic version of journal.