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VOLUME 10 , ISSUE 1--4 ( January-December, 2024 ) > List of Articles


Retrospective Survey of Purpose and Outcome of Preoperative Cardiology Opinion for Patients Undergoing Intermediate-risk Noncardiac Surgeries at a Tertiary Care Center

Ashwini Hungund, Rashmi Raghavendra, Ranjini Shome, Arko Misra

Keywords : Cardiology opinion, Elective surgery, Preanesthesia check-up

DOI: 10.5005/jp-journals-10045-00242

License: NA

Published Online: 24-04-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Background: In the current perioperative care, the practice of getting routine investigations and specialty opinions for minor and intermediate surgeries is questioned as it adds to the cost of healthcare without any change in perioperative management and outcome. We did a retrospective study to find out the validity of cardiology opinions for minor and intermediate surgeries in a tertiary care teaching center. Objective: To investigate the role of cardiology opinion for intermediate/low-risk surgeries in terms of change in treatment, change in anesthetic management, further coronary artery disease (CAD) workup, and predicting adverse perioperative events. Materials and methods: Retrospective study of the case files of patients who had undergone minor/intermediate risk surgeries. Only those patients’ case files with good functional capacity were considered. We looked for the reason for obtaining cardiology opinion, the outcome of opinion in terms of change in treatment, further workup, advice for any change in anesthetic management, and predicting adverse perioperative outcomes. Results: A total of 32% of the opinions were sought for patients without any risk factors for major adverse cardiac events (MACE). Overall, 73 requests by both surgeons and anesthesiologists (69%) did not specify the reason for cardiology opinion. Clearance for the surgery was the most common reason quoted by surgeons for cardiology consultation. Electrocardiogram (ECG) changes were the reason for this, as quoted by anesthesiologists. Antihypertensive medications were started only for four patients. Except in one case, none of the patients had any problems during the perioperative period. All cases were managed as per routine protocols. Conclusion: Cardiology opinion for minor/intermediate risk surgeries has not contributed to perioperative management or in predicting complications. The practice of obtaining cardiology opinions does not follow the guidelines. Cardiology consultation for risk stratification and clearance for surgery should not be done; rather, a request should be made if it is going to change the course of perioperative management.

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  1. Aslanger E, Altun I, Guz G, et al. The preoperative cardiology consultation: goal settings and great expectations. Acta Cardiol 2011;66(4):447–452. DOI: 10.1080/ac.66.4.2126592
  2. Katz RI, Barnhart JM, Ho G, et al. A survey on the intended purposes and perceived utility of preoperative cardiology consultations. Anesth Analg 1998;87(4):830–836. DOI: 10.1097/00000539-199810000-00016
  3. Palmer J. Hypertension and perioperative risk. Br J Anaesth 2004;93(2):305. DOI: 10.1093/bja/aeh592
  4. Spahn DR, Priebe HJ. Preoperative hypertension: remain wary? ‘Yes’- cancel surgery? ‘No.’ Bri J Anaesth 2004;92(4):461–464. DOI: 10.1093/bja/aeh085
  5. Goldberger's clinical electrocardiography. A simplified approach. 8th edition. ECG basics: waves, intervals and segments, p. 15.
  6. Fleisher LA. The preoperative electrocardiogram: what is the role in 2007? Ann Surg 2007;246(2):171–172. DOI: 10.1097/SLA.0b013e31811eb927
  7. Committee on Standards and Practice Parameters, Apfelbaum JL, Connis RT, et al. Practice advisory for preanesthesia evaluation: an updated report by the American Society of Anesthesiologists Task Force on Preanesthesia Evaluation. Anesthesiology 2012;116(3):522–538. DOI: 10.1097/ALN.0b013e31823c1067
  8. Fleisher LA, Fleischmann KE, Auerbach AD, et al. 2014 ACC/AHA Guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines. Circulation 2014;130(24):2215–2245. DOI: 10.1161/CIR.0000000000000105
  9. Park KW, David C. Preoperative cardiology consultation. Anesthesiology 2003;98:754–762. DOI: 10.1097/00000542-200303000-00027
  11. Eliassen AM, Davis FM, Philips AR, et al. Effect of preoperative cardiology speciality consultations prior to elective aortic aneurysm repair on patient morbidity. J Vasc Surg 2015;61(6 suppl):58S. DOI: 1016/j.jvs.2015.04.106
  12. Karim HMR. Is majority of requests by anesthesiologists for cardiologist consultation unjustified? Anaesth Pain Intensive Care 2016;20(suppl 1):S109–S114.
  13. Kleinman B. Preoperative cardiology consultation: how helpful is it? Anesthesiology 2003;99(5):1240; author reply 1241–1240; author reply 1242. DOI: 10.1097/00000542-200311000-00044
  14. Kristensen SD, Knuuti J, Saraste A, et al. 2014 ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assessment and management: 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). Eur Heart J 2014;35(35):2383–2431. DOI: 10.1093/eurheartj/ehu282
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