BACKGROUND: Increasingly patients undergoing non-cardiac surgery are older and have more comorbidities yet pre-operative cardiac assessment appears haphazard and unsystematic. We hypothesized that patients at high cardiac risk were not receiving adequate cardiac assessment and patients with low-cardiac risk were being over-investigated. METHODS: We examined cardiac assessment patterns prior to elective non-cardiac surgery in a representative sample of patients. Cardiac risk was calculated using the revised cardiac risk index (RCRI). RESULTS: Of 671 patients, 589 (88%) were low risk and 82 (12%) were high risk. We found nearly 14% of low risk and 45% of high risk patients had investigations for coronary ischaemia prior to surgery. Vascular surgery had the highest rate of investigation (38%), thoracic patients the lowest rate (14%). Whilst 78% of high risk patients had coronary disease, only 46% were on beta-blockers, 49% on aspirin and 77% on statins. For current smokers (17.3% of cohort, n = 98), 60% were advised to quit pre-op. CONCLUSIONS: Practice patterns varied across surgical sub-types with low-risk patients tending to be over-investigated and high-risk patients under-investigated. A more systemized approach to this large group of patients could improve clinical outcomes, and more judicious use of investigations could lower health care costs and increase efficiency in managing this cohort.
AD - PhD student, The George Institute for Global Health, University of Sydney, Sydney. Australia. Cardiology Trainee, Westmead Hospital, Westmead, Sydney, Australia.BACKGROUND: Increasingly patients undergoing non-cardiac surgery are older and have more comorbidities yet pre-operative cardiac assessment appears haphazard and unsystematic. We hypothesized that patients at high cardiac risk were not receiving adequate cardiac assessment and patients with low-cardiac risk were being over-investigated. METHODS: We examined cardiac assessment patterns prior to elective non-cardiac surgery in a representative sample of patients. Cardiac risk was calculated using the revised cardiac risk index (RCRI). RESULTS: Of 671 patients, 589 (88%) were low risk and 82 (12%) were high risk. We found nearly 14% of low risk and 45% of high risk patients had investigations for coronary ischaemia prior to surgery. Vascular surgery had the highest rate of investigation (38%), thoracic patients the lowest rate (14%). Whilst 78% of high risk patients had coronary disease, only 46% were on beta-blockers, 49% on aspirin and 77% on statins. For current smokers (17.3% of cohort, n = 98), 60% were advised to quit pre-op. CONCLUSIONS: Practice patterns varied across surgical sub-types with low-risk patients tending to be over-investigated and high-risk patients under-investigated. A more systemized approach to this large group of patients could improve clinical outcomes, and more judicious use of investigations could lower health care costs and increase efficiency in managing this cohort.
PY - 2016 SN - 1445-5994 (Electronic)