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BEHAVIOR OF PHYSICIANS IN PRE-OPERATIVE ASSESSMENT

Dept. of Anesthesia University Health Network 200 Elizabeth St. Toronto M5G 2C4

INTRODUCTION

Pre-operative cardiac assessment of patients having surgery is important to identify patients at risk. We know little of how clinical physician evaluate risk in patients undergoing non-cardiac surgery. Persantine Thallium and Echocardiography have demonstrated to be predictors of cardiac events. These tests add predictive value in moderate risk patients only.

DESIGN

After approval of the hospital ethics committee a retrospective study was conducted for twelve consecutive months in the year 2001 at a university affiliated hospital. A total of 113 patients were seen by medicine and anesthesia pre-operatively scheduled for abdominal, vascular, and thoracic surgery. We assessed the ability of consultants to assign cardiac risk, the pattern of ordering non-invasive testing, and changes in medical management. Further, we evaluated the surgical outcomes cancellation, myocardial infarction, death, within the immediate post-operative period up to 30 days post-op. Outcomes were correlated with patients' risks, testing and treatments used peri-operatively

RESULTS

Eleven percent of physicians used a validated clinical risk index. We retrospectively assigned a Lee Risk Score1 to each patient. 60 thallium and 68 2D echocardiogram examinations were ordered 42 % of Thallium tests and 50% of the 2D echocardiograms were performed in low risk patients (Lee Risk <3). No morbid clinical events occurred in any of these low risk patients. Twelve high risk patients had no further cardiac testing performed. High risk patients with positive thallium exams resulted in the following medical management changes. (27% had a beta blocker started; 20% of patients were cancelled; 20% referred to cardiology; 10% had nitrates started; 5% had a platelet inhibitors or calcium channel blockers started; 13% of patients had no change in medical management).

DISSCUSSION

The use of a risk index defining cardiac risk in patients going for non-cardiac surgery is low . Application of such an index would result in few tests being ordered with no change in outcome. Changes in medical management are variable and depend on the consultant.

REFERENCES

1 Circulation 1999: 100; 1043[Abstract/Free Full Text]

This Article Full Text (PDF) Submit a scholarly reply Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Beattie, W.S. Articles by Hurtado, C. Search for Related Content PubMed Articles by Beattie, W.S. Articles by Hurtado, C.