151
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Donovan RJ, Choi C, Ali A, Heuman DM, Fuchs M, Bavry AA, Jovin IS. Perioperative Cardiovascular Evaluation for Orthotopic Liver Transplantation. Dig Dis Sci 2017; 62:26-34. [PMID: 27830409 DOI: 10.1007/s10620-016-4371-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 11/01/2016] [Indexed: 01/01/2023]
Abstract
Patients with advanced liver disease have a high prevalence of cardiovascular risk factors, but many of them are asymptomatic. Cardiovascular risk stratification prior to liver transplant can be done by dobutamine stress echocardiography, stress myocardial perfusion imaging, cardiac computer tomography, and coronary angiography, but there are no clear recommendations regarding what method should be used and who should be screened. Because of this and because of inherent risk profile in this population, the variations in practice are significant. Careful screening and rigorous management of cardiovascular risk factors are important to ensure optimal cardiovascular outcomes in the immediate post-transplantation period and in the long term as well.
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Affiliation(s)
- Robert J Donovan
- Department of Medicine, Virginia Commonwealth University, McGuire VAMC, Richmond, VA, USA
| | - Calvin Choi
- Department of Medicine, Randall VAMC, University of Florida, Gainesville, FL, USA
| | - Asghar Ali
- Department of Medicine, Virginia Commonwealth University, McGuire VAMC, Richmond, VA, USA.
| | - Douglas M Heuman
- Department of Medicine, Virginia Commonwealth University, McGuire VAMC, Richmond, VA, USA
| | - Michael Fuchs
- Department of Medicine, Virginia Commonwealth University, McGuire VAMC, Richmond, VA, USA
| | - Anthony A Bavry
- Department of Medicine, Randall VAMC, University of Florida, Gainesville, FL, USA
| | - Ion S Jovin
- Department of Medicine, Virginia Commonwealth University, McGuire VAMC, Richmond, VA, USA
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152
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Kyo S, Imanaka K, Masuda M, Miyata T, Morita K, Morota T, Nomura M, Saiki Y, Sawa Y, Sueda T, Ueda Y, Yamazaki K, Yozu R, Iwamoto M, Kawamoto S, Koyama I, Kudo M, Matsumiya G, Orihashi K, Oshima H, Saito S, Sakamoto Y, Shigematsu K, Taketani T, Komuro I, Takamoto S, Tei C, Yamamoto F. Guidelines for Perioperative Cardiovascular Evaluation and Management for Noncardiac Surgery (JCS 2014) ― Digest Version ―. Circ J 2017; 81:245-267. [DOI: 10.1253/circj.cj-66-0135] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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153
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Sung TY, Cho CK. Preoperative assessment of geriatric patients. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2017. [DOI: 10.5124/jkma.2017.60.5.364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Tae-Yun Sung
- Department of Anaesthesiology and Pain Medicine, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
| | - Choon-Kyu Cho
- Department of Anaesthesiology and Pain Medicine, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
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154
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Abstract
Geriatric patients are over-represented in hospitalizations, surgeries, and perioperative complications. Special consideration is required for this patient group in the perioperative period because of the prevalence of comorbid diseases, functional impairments, and other deficits. A comprehensive preoperative evaluation strategy is recommended to identify and address these issues. Systematic, multidomain assessments should be performed and paired with risk reduction efforts. A shared understanding of patient function and long-term health goals is also important for providing patient-centered care of the geriatric surgical patient.
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155
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Mehdi Z, Birns J, Partridge J, Bhalla A, Dhesi J. Perioperative management of adult patients with a history of stroke or transient ischaemic attack undergoing elective non-cardiac surgery. Clin Med (Lond) 2016; 16:535-540. [PMID: 27927817 PMCID: PMC6297334 DOI: 10.7861/clinmedicine.16-6-535] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
It is increasingly common for physicians and anaesthetists to be asked for advice in the medical management of surgical patients who have an incidental history of stroke or transient ischaemic attack (TIA). Advising clinicians requires an understanding of the common predictors, outcomes and management of perioperative stroke. The most important predictor of perioperative stroke is a previous history of stroke, and outcomes associated with such an event are extremely poor. The perioperative management of this patient group needs careful consideration to minimise the thrombotic risk and a comprehensive, individualised approach is crucial. Although there is literature supporting the management of such patients undergoing cardiac surgery, evidence is lacking in the setting of non-cardiac surgical intervention. This article reviews the current evidence and provides a pragmatic interpretation to inform the perioperative management of patients with a history of stroke and/or TIA presenting for elective non-cardiac surgery.
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Affiliation(s)
- Zehra Mehdi
- Department of Ageing and Health, St Thomas' Hospital, London, UK
| | - Jonathan Birns
- Department of Ageing and Health, St Thomas' Hospital, London, UK
| | - Judith Partridge
- Department of Ageing and Health, St Thomas' Hospital, London, UK
| | - Ajay Bhalla
- Department of Ageing and Health, St Thomas' Hospital, London, UK
| | - Jugdeep Dhesi
- Department of Ageing and Health, St Thomas' Hospital, London, UK
- Division of Health and Social Care Research, Kings College London, London, UK
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156
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Duceppe E, Parlow J, MacDonald P, Lyons K, McMullen M, Srinathan S, Graham M, Tandon V, Styles K, Bessissow A, Sessler DI, Bryson G, Devereaux PJ. Canadian Cardiovascular Society Guidelines on Perioperative Cardiac Risk Assessment and Management for Patients Who Undergo Noncardiac Surgery. Can J Cardiol 2016; 33:17-32. [PMID: 27865641 DOI: 10.1016/j.cjca.2016.09.008] [Citation(s) in RCA: 429] [Impact Index Per Article: 53.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 09/20/2016] [Accepted: 09/21/2016] [Indexed: 02/06/2023] Open
Abstract
The Canadian Cardiovascular Society Guidelines Committee and key Canadian opinion leaders believed there was a need for up to date guidelines that used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system of evidence assessment for patients who undergo noncardiac surgery. Strong recommendations included: 1) measuring brain natriuretic peptide (BNP) or N-terminal fragment of proBNP (NT-proBNP) before surgery to enhance perioperative cardiac risk estimation in patients who are 65 years of age or older, are 45-64 years of age with significant cardiovascular disease, or have a Revised Cardiac Risk Index score ≥ 1; 2) against performing preoperative resting echocardiography, coronary computed tomography angiography, exercise or cardiopulmonary exercise testing, or pharmacological stress echocardiography or radionuclide imaging to enhance perioperative cardiac risk estimation; 3) against the initiation or continuation of acetylsalicylic acid for the prevention of perioperative cardiac events, except in patients with a recent coronary artery stent or who will undergo carotid endarterectomy; 4) against α2 agonist or β-blocker initiation within 24 hours before surgery; 5) withholding angiotensin-converting enzyme inhibitor and angiotensin II receptor blocker starting 24 hours before surgery; 6) facilitating smoking cessation before surgery; 7) measuring daily troponin for 48 to 72 hours after surgery in patients with an elevated NT-proBNP/BNP measurement before surgery or if there is no NT-proBNP/BNP measurement before surgery, in those who have a Revised Cardiac Risk Index score ≥1, age 45-64 years with significant cardiovascular disease, or age 65 years or older; and 8) initiating of long-term acetylsalicylic acid and statin therapy in patients who suffer myocardial injury/infarction after surgery.
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Affiliation(s)
- Emmanuelle Duceppe
- Department of Medicine, University of Montreal, Montreal, Quebec, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Joel Parlow
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ontario, Canada.
| | - Paul MacDonald
- Cape Breton Regional Hospital, Cape Breton, Nova Scotia, Canada
| | - Kristin Lyons
- Division of Cardiology, University of Calgary, Calgary, Alberta, Canada
| | - Michael McMullen
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ontario, Canada
| | - Sadeesh Srinathan
- Department of Surgery, Section of Thoracic Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Michelle Graham
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Vikas Tandon
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Kim Styles
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Amal Bessissow
- Division of General Internal Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Daniel I Sessler
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Gregory Bryson
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - P J Devereaux
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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157
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Levine GN, Bates ER, Bittl JA, Brindis RG, Fihn SD, Fleisher LA, Granger CB, Lange RA, Mack MJ, Mauri L, Mehran R, Mukherjee D, Newby LK, O’Gara PT, Sabatine MS, Smith PK, Smith SC. 2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines: An Update of the 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention, 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery, 2012 ACC/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease, 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction, 2014 AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes, and 2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery. Circulation 2016; 134:e123-55. [PMID: 27026020 DOI: 10.1161/cir.0000000000000404] [Citation(s) in RCA: 938] [Impact Index Per Article: 117.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Glenn N. Levine
- Focused Update writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. Evidence Review Committee Chair. American Society of Anesthesiologists/Society of Cardiovascular Anesthesiologists Representative. American Association for Thoracic Surgery/Society of Thoracic Surgeons Representative
| | - Eric R. Bates
- Focused Update writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. Evidence Review Committee Chair. American Society of Anesthesiologists/Society of Cardiovascular Anesthesiologists Representative. American Association for Thoracic Surgery/Society of Thoracic Surgeons Representative
| | - John A. Bittl
- Focused Update writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. Evidence Review Committee Chair. American Society of Anesthesiologists/Society of Cardiovascular Anesthesiologists Representative. American Association for Thoracic Surgery/Society of Thoracic Surgeons Representative
| | - Ralph G. Brindis
- Focused Update writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. Evidence Review Committee Chair. American Society of Anesthesiologists/Society of Cardiovascular Anesthesiologists Representative. American Association for Thoracic Surgery/Society of Thoracic Surgeons Representative
| | - Stephan D. Fihn
- Focused Update writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. Evidence Review Committee Chair. American Society of Anesthesiologists/Society of Cardiovascular Anesthesiologists Representative. American Association for Thoracic Surgery/Society of Thoracic Surgeons Representative
| | - Lee A. Fleisher
- Focused Update writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. Evidence Review Committee Chair. American Society of Anesthesiologists/Society of Cardiovascular Anesthesiologists Representative. American Association for Thoracic Surgery/Society of Thoracic Surgeons Representative
| | - Christopher B. Granger
- Focused Update writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. Evidence Review Committee Chair. American Society of Anesthesiologists/Society of Cardiovascular Anesthesiologists Representative. American Association for Thoracic Surgery/Society of Thoracic Surgeons Representative
| | - Richard A. Lange
- Focused Update writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. Evidence Review Committee Chair. American Society of Anesthesiologists/Society of Cardiovascular Anesthesiologists Representative. American Association for Thoracic Surgery/Society of Thoracic Surgeons Representative
| | - Michael J. Mack
- Focused Update writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. Evidence Review Committee Chair. American Society of Anesthesiologists/Society of Cardiovascular Anesthesiologists Representative. American Association for Thoracic Surgery/Society of Thoracic Surgeons Representative
| | - Laura Mauri
- Focused Update writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. Evidence Review Committee Chair. American Society of Anesthesiologists/Society of Cardiovascular Anesthesiologists Representative. American Association for Thoracic Surgery/Society of Thoracic Surgeons Representative
| | - Roxana Mehran
- Focused Update writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. Evidence Review Committee Chair. American Society of Anesthesiologists/Society of Cardiovascular Anesthesiologists Representative. American Association for Thoracic Surgery/Society of Thoracic Surgeons Representative
| | - Debabrata Mukherjee
- Focused Update writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. Evidence Review Committee Chair. American Society of Anesthesiologists/Society of Cardiovascular Anesthesiologists Representative. American Association for Thoracic Surgery/Society of Thoracic Surgeons Representative
| | - L. Kristin Newby
- Focused Update writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. Evidence Review Committee Chair. American Society of Anesthesiologists/Society of Cardiovascular Anesthesiologists Representative. American Association for Thoracic Surgery/Society of Thoracic Surgeons Representative
| | - Patrick T. O’Gara
- Focused Update writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. Evidence Review Committee Chair. American Society of Anesthesiologists/Society of Cardiovascular Anesthesiologists Representative. American Association for Thoracic Surgery/Society of Thoracic Surgeons Representative
| | - Marc S. Sabatine
- Focused Update writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. Evidence Review Committee Chair. American Society of Anesthesiologists/Society of Cardiovascular Anesthesiologists Representative. American Association for Thoracic Surgery/Society of Thoracic Surgeons Representative
| | - Peter K. Smith
- Focused Update writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. Evidence Review Committee Chair. American Society of Anesthesiologists/Society of Cardiovascular Anesthesiologists Representative. American Association for Thoracic Surgery/Society of Thoracic Surgeons Representative
| | - Sidney C. Smith
- Focused Update writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. Evidence Review Committee Chair. American Society of Anesthesiologists/Society of Cardiovascular Anesthesiologists Representative. American Association for Thoracic Surgery/Society of Thoracic Surgeons Representative
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158
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Affiliation(s)
- Nathaniel R Smilowitz
- From Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, NY (N.R.S., J.S.B.); Division of Hematology, Department of Medicine, New York University School of Medicine, New York, NY (J.S.B.); and Division of Vascular Surgery, Department of Surgery, New York University School of Medicine, New York, NY (J.S.B.)
| | - Jeffrey S Berger
- From Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, NY (N.R.S., J.S.B.); Division of Hematology, Department of Medicine, New York University School of Medicine, New York, NY (J.S.B.); and Division of Vascular Surgery, Department of Surgery, New York University School of Medicine, New York, NY (J.S.B.).
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159
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Postoperative complications in cardiac patients undergoing noncardiac surgery. Curr Opin Crit Care 2016; 22:357-64. [DOI: 10.1097/mcc.0000000000000315] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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160
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Priebe HJ. Pharmacological modification of the perioperative stress response in noncardiac surgery. Best Pract Res Clin Anaesthesiol 2016; 30:171-89. [DOI: 10.1016/j.bpa.2016.03.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 03/21/2016] [Accepted: 03/31/2016] [Indexed: 11/26/2022]
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161
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Guazzi M, Arena R, Halle M, Piepoli MF, Myers J, Lavie CJ. 2016 focused update: clinical recommendations for cardiopulmonary exercise testing data assessment in specific patient populations. Eur Heart J 2016; 39:1144-1161. [DOI: 10.1093/eurheartj/ehw180] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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162
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Guazzi M, Arena R, Halle M, Piepoli MF, Myers J, Lavie CJ. 2016 Focused Update: Clinical Recommendations for Cardiopulmonary Exercise Testing Data Assessment in Specific Patient Populations. Circulation 2016; 133:e694-711. [PMID: 27143685 DOI: 10.1161/cir.0000000000000406] [Citation(s) in RCA: 245] [Impact Index Per Article: 30.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
In the past several decades, cardiopulmonary exercise testing (CPX) has seen an exponential increase in its evidence base. The growing volume of evidence in support of CPX has precipitated the release of numerous scientific statements by societies and associations. In 2012, the European Association for Cardiovascular Prevention & Rehabilitation and the American Heart Association developed a joint document with the primary intent of redefining CPX analysis and reporting in a way that would streamline test interpretation and increase clinical application. Specifically, the 2012 joint scientific statement on CPX conceptualized an easy-to-use, clinically meaningful analysis based on evidence-vetted variables in color-coded algorithms; single-page algorithms were successfully developed for each proposed test indication. Because of an abundance of new CPX research in recent years and a reassessment of the current algorithms in light of the body of evidence, a focused update to the 2012 scientific statement is now warranted. The purposes of this update are to confirm algorithms included in the initial scientific statement not requiring revision, to propose revisions to algorithms included in the initial scientific statement, to propose new algorithms based on emerging scientific evidence, to further clarify the application of oxygen consumption at ventilatory threshold, to describe CPX variables with an emerging scientific evidence base, to describe the synergistic value of combining CPX with other assessments, to discuss personnel considerations for CPX laboratories, and to provide recommendations for future CPX research.
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163
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Wijeysundera DN. Preoperative treatment with β-blockers is associated with elevated postoperative mortality and cardiac morbidity in patients with uncomplicated hypertension undergoing non-cardiac surgery. EVIDENCE-BASED MEDICINE 2016; 21:114-5. [PMID: 27048839 DOI: 10.1136/ebmed-2016-110395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Duminda N Wijeysundera
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada Department of Anesthesia, Toronto General Hospital and University of Toronto, Toronto, Ontario, Canada Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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164
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Wong SSC, Irwin MG. Peri-operative cardiac protection for non-cardiac surgery. Anaesthesia 2016; 71 Suppl 1:29-39. [PMID: 26620144 DOI: 10.1111/anae.13305] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2015] [Indexed: 10/22/2022]
Abstract
Cardiovascular complications are an important cause of morbidity and mortality after non-cardiac surgery. Pre-operative identification of high-risk individuals and appropriate peri-operative management can reduce cardiovascular risk. It is important to continue chronic beta-blocker and statin therapy. Statins are relatively safe and peri-operative initiation may be beneficial in high-risk patients and those scheduled for vascular surgery. The pre-operative introduction of beta-blockers reduces myocardial injury but increases rates of stroke and mortality, possibly due to hypotension. They should only be considered in high-risk patients and the dose should be titrated to heart rate. Alpha-2 agonists may also contribute to hypotension. Aspirin continuation can increase the risk of major bleeding and offset the benefit of reduced myocardial risk. Contrary to the initial ENIGMA study, nitrous oxide does not seem to increase the risk of myocardial injury. Volatile anaesthetic agents and opioids have been shown to be cardioprotective in animal laboratory studies but these effects have, so far, not been conclusively reproduced clinically.
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Affiliation(s)
- S S C Wong
- Department of Anaesthesia, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - M G Irwin
- Department of Anaesthesia, The University of Hong Kong, Hong Kong Special Administrative Region, China
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165
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Wijeysundera DN, Pearse RM, Shulman MA, Abbott TEF, Torres E, Croal BL, Granton JT, Thorpe KE, Grocott MPW, Farrington C, Myles PS, Cuthbertson BH. Measurement of Exercise Tolerance before Surgery (METS) study: a protocol for an international multicentre prospective cohort study of cardiopulmonary exercise testing prior to major non-cardiac surgery. BMJ Open 2016; 6:e010359. [PMID: 26969643 PMCID: PMC4800144 DOI: 10.1136/bmjopen-2015-010359] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Preoperative functional capacity is considered an important risk factor for cardiovascular and other complications of major non-cardiac surgery. Nonetheless, the usual approach for estimating preoperative functional capacity, namely doctors' subjective assessment, may not accurately predict postoperative morbidity or mortality. 3 possible alternatives are cardiopulmonary exercise testing; the Duke Activity Status Index, a standardised questionnaire for estimating functional capacity; and the serum concentration of N-terminal pro-B-type natriuretic peptide (NT pro-BNP), a biomarker for heart failure and cardiac ischaemia. METHODS AND ANALYSIS The Measurement of Exercise Tolerance before Surgery (METS) Study is a multicentre prospective cohort study of patients undergoing major elective non-cardiac surgery at 25 participating study sites in Australia, Canada, New Zealand and the UK. We aim to recruit 1723 participants. Prior to surgery, participants undergo symptom-limited cardiopulmonary exercise testing on a cycle ergometer, complete the Duke Activity Status Index questionnaire, undergo blood sampling to measure serum NT pro-BNP concentration and have their functional capacity subjectively assessed by their responsible doctors. Participants are followed for 1 year after surgery to assess vital status, postoperative complications and general health utilities. The primary outcome is all-cause death or non-fatal myocardial infarction within 30 days after surgery, and the secondary outcome is all-cause death within 1 year after surgery. Both receiver-operating-characteristic curve methods and risk reclassification table methods will be used to compare the prognostic accuracy of preoperative subjective assessment, peak oxygen consumption during cardiopulmonary exercise testing, Duke Activity Status Index scores and serum NT pro-BNP concentration. ETHICS AND DISSEMINATION The METS Study has received research ethics board approval at all sites. Participant recruitment began in March 2013, and 1-year follow-up is expected to finish in 2016. Publication of the results of the METS Study is anticipated to occur in 2017.
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Affiliation(s)
- Duminda N Wijeysundera
- St. Michael's Hospital/Toronto General Hospital/University of Toronto, Toronto, Ontario, Canada
| | | | - Mark A Shulman
- Alfred Hospital/Monash University, Melbourne, Victoria, Australia
| | | | | | | | - John T Granton
- University Health Network/Mount Sinai Hospital/University of Toronto, Toronto, Ontario, Canada
| | - Kevin E Thorpe
- University of Toronto/St. Michael's Hospital, Toronto, Ontario, Canada
| | | | | | - Paul S Myles
- Alfred Hospital/Monash University, Melbourne, Victoria, Australia
| | - Brian H Cuthbertson
- Sunnybrook Health Sciences Centre/University of Toronto, Toronto, Ontario, Canada
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166
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Li YF, Gao WQ, Li YX, Feng QZ, Zhu P. Management of acute perioperative myocardial infarction: a case report of concomitant acute myocardial infarction and tumor bleeding in the transverse colon. Clin Interv Aging 2016; 11:159-66. [PMID: 26937182 PMCID: PMC4762468 DOI: 10.2147/cia.s91918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Acute myocardial infarction complicated by bleeding colon tumor is problematic with regard to management, and appropriate balance of antiplatelet or anticoagulation therapy and hemostasis or surgery is crucial for effective treatment. Here, we present a case of concomitant acute myocardial infarction and bleeding tumor in the transverse colon, and share our experience of successfully balancing anticoagulation therapy and hemostasis.
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Affiliation(s)
- Yu-Feng Li
- The Department of Cardiology, Clinical Division of Medicine, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Wen-Qian Gao
- The Department of Cardiology, Clinical Division of Nanlou, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Yuan-Xin Li
- Navy Wangshoulu Clinics, Beijing, People's Republic of China
| | - Quan-Zhou Feng
- The Department of Cardiology, Clinical Division of Medicine, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Ping Zhu
- The Department of Cardiology, Clinical Division of Nanlou, Chinese PLA General Hospital, Beijing, People's Republic of China
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167
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Affiliation(s)
- Iftikhar J Kullo
- From the Division of Cardiovascular Diseases and the Gonda Vascular Center, Mayo Clinic, Rochester, MN
| | - Thom W Rooke
- From the Division of Cardiovascular Diseases and the Gonda Vascular Center, Mayo Clinic, Rochester, MN
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Réplica a la Carta al Editor: Manual de práctica clínica basado en la evidencia: preparación del paciente para el acto quirúrgico y traslado al quirófano. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2016. [DOI: 10.1016/j.rca.2015.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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169
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Martínez-Rubio A, Alcazar MD, Cadena AS, Martínez-Torrecilla R. Using Direct Oral Anticoagulants in Patients with Atrial Fibrillation: Assessment, Monitoring and Treatment Reversal. Eur Cardiol 2016; 11:118-122. [PMID: 30310459 DOI: 10.15420/ecr.2016:30:1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
It is essential to prevent thromboembolic events in atrial fibrillation. The risks of thromboembolic and haemorrhagic events must be carefully assessed and weighed against one another, both in routine situations and in relation to invasive procedures. Vitamin K antagonists, until recently the first-line treatment for prophylaxis against thromboembolic events in patients with atrial fibrillation, have various drawbacks. Direct-acting oral anticoagulants overcome these limitations and are efficacious and safe. The recent developments of tests to monitor anticoagulant levels, and of target-specific reversal agents for these newer drugs, has facilitated their use in several situations, including emergencies. For these reasons, the European Society of Cardiology and other scientific societies now recommend direct-acting oral anticoagulants as first-line treatment for preventing thromboembolic events in atrial fibrillation.
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Affiliation(s)
- Antoni Martínez-Rubio
- Department of Cardiology, University Hospital Sabadell, Autonomous University of Barcelona, Barcelona, Spain and the International Society of Cardiovascular Pharmacotherapy
| | - Mario DiazNuila Alcazar
- Department of Cardiology, University Hospital Sabadell, Autonomous University of Barcelona, Barcelona, Spain and the International Society of Cardiovascular Pharmacotherapy
| | - Anna Soria Cadena
- Department of Cardiology, University Hospital Sabadell, Autonomous University of Barcelona, Barcelona, Spain and the International Society of Cardiovascular Pharmacotherapy
| | - Roger Martínez-Torrecilla
- Department of Cardiology, University Hospital Sabadell, Autonomous University of Barcelona, Barcelona, Spain and the International Society of Cardiovascular Pharmacotherapy
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Reply to the Letter to the Editor: Evidence based clinical practice manual: Patient preparation for surgery and transfer to the operating room theater. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2016. [DOI: 10.1016/j.rcae.2015.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Evidence based clinical practice manual: Patient preparation for surgery and transfer to the operating room☆. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2016. [DOI: 10.1097/01819236-201644010-00015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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172
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Reply to the Letter to the Editor: Evidence based clinical practice manual: Patient preparation for surgery and transfer to the operating room theater☆. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2016. [DOI: 10.1097/01819236-201644010-00016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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173
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Letter to the Editor: Evidence based clinical practice manual: Patient preparation for surgery and transfer to the operating room. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2016. [DOI: 10.1016/j.rcae.2015.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Wijeysundera DN. Predicting outcomes: Is there utility in risk scores? Can J Anaesth 2015; 63:148-58. [PMID: 26670801 DOI: 10.1007/s12630-015-0537-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 10/19/2015] [Accepted: 11/11/2015] [Indexed: 12/28/2022] Open
Abstract
PURPOSE This review discusses the utility of risk scores, specifically, the role of preoperative risk scores in guiding the management of surgical patients, approaches to evaluate the quality of risk scores, and limitations to consider when applying risk scores in clinical practice. PRINCIPAL FINDINGS This review shows how accurate predictions of perioperative risk can help inform patients and clinicians with respect to decision-making around surgery; identify patients who warrant further specialized investigations, new interventions intended to decrease risk, modifications in planned operative procedures, or intensification of postoperative monitoring; and facilitate fairer comparisons of outcomes between providers and hospitals. A preoperative risk score formally integrates several pieces of clinical information (e.g., age, comorbid disease, laboratory tests) to arrive at an overall estimate of an individual patient's expected risk for specific postoperative adverse events. A good risk score should be simple to incorporate in clinical practice, reliable when applied by different raters, and accurate at predicting postoperative risk. Several analytical methods (e.g., receiver operating characteristic curves, likelihood ratios, risk reclassification tables, observed vs predicted plots) are required to characterize the relevant domains that encompass the prognostic accuracy of a risk score. External validation is critical in determining whether the predictive accuracy of a risk score is preserved when applied to new settings, populations, or outcome events. CONCLUSIONS Preoperative risk scores help inform perioperative clinical decision-making. Future research must determine how estimates of preoperative risk can be updated with information from the intraoperative period, how risk information should be communicated to patients, and which interventions can improve outcomes among patients within newly identified risk strata.
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Affiliation(s)
- Duminda N Wijeysundera
- Department of Anesthesia, Toronto General Hospital and University of Toronto, Toronto, ON, Canada.
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada.
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada.
- Department of Anesthesia and Pain Management, Toronto General Hospital, Eaton Wing 3-450, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada.
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Controversies in perioperative anesthetic management of the morbidly obese: I am a surgeon, why should I care? Obes Surg 2015; 25:879-87. [PMID: 25726320 DOI: 10.1007/s11695-015-1635-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Over the last four decades, as the rates of obesity have increased, so have the challenges associated with its anesthetic management. In the present review, we discuss perioperative anesthesia management issues that are modifiable by the early involvement of the surgical team. We sum up available evidence or expert opinion on issues like patient positioning, postoperative analgesia, and the effect of continuous positive airway pressure (CPAP) ventilation on surgical anastomosis. We also address established predictors of higher perioperative risk and suggest possible management strategies and concerns of obese patients undergoing same day procedures. Finally, a generalized pharmacological model relevant to altered pharmacokinetics in these patients is presented.
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García PS, Duggan EW, McCullough IL, Lee SC, Fishman D. Postanesthesia Care for the Elderly Patient. Clin Ther 2015; 37:2651-65. [PMID: 26598176 DOI: 10.1016/j.clinthera.2015.10.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 10/20/2015] [Accepted: 10/21/2015] [Indexed: 12/17/2022]
Abstract
PURPOSE As the general population lives longer, the perioperative physician is more likely to encounter disease states that increase in incidence in an aging population. This review focuses on anesthetic considerations for rational drug choices during the perioperative care of elderly patients. The primary aim of the review was to identify intraoperative and postanesthetic considerations for diseases associated with advancing age; it includes highlights of the commonly impaired major organs (eg, cardiovascular, pulmonary, neurologic, renal, hepatic systems). We also outline an approach to frequent issues that arise in the immediate postsurgical period while caring for these patients. METHODS A systematic review was performed on aspects of the perioperative and postoperative periods that relate to the elderly. A list of pertinent key words was derived from the authors, and a PubMed database search was performed. FINDINGS The anesthesiologist must account for changes in various organ systems that affect perioperative care, including the cardiovascular, pulmonary, renal, hepatic, and central nervous systems. The pharmacokinetic principles frequently differ and are often unpredictable because of anatomic changes and decreased renal and hepatic function. The most important pharmacodynamic consideration is that elderly patients tend to exhibit an exaggerated hypoactivity after anesthesia. IMPLICATIONS Before surgery, it is essential to identify those patients at risk for delirium and other commonly encountered postanesthesia scenarios. Failure to manage these conditions appropriately can lead to an escalation of care and prolonged hospitalization.
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Affiliation(s)
- Paul S García
- US Department of Veterans Affairs, Atlanta VA Medical Center, Decatur, Georgia; Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia.
| | - Elizabeth W Duggan
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia
| | - Ian L McCullough
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia
| | - Simon C Lee
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia
| | - David Fishman
- US Department of Veterans Affairs, Atlanta VA Medical Center, Decatur, Georgia; Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia
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Bader AM, Fox JA, Hepner DL. Channeling Phaedrus: How Do the 2007 and 2014 ACC/AHA Guidelines Compare on the Horns of a Dilemma? J Cardiothorac Vasc Anesth 2015; 29:1408-9. [PMID: 26456272 DOI: 10.1053/j.jvca.2015.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Angela M Bader
- Department of Anesthesiology Perioperative and Pain Medicine Brigham and Women's Hospital Harvard Medical School, Boston, MA
| | - John A Fox
- Department of Anesthesiology Perioperative and Pain Medicine Brigham and Women's Hospital Harvard Medical School, Boston, MA
| | - David L Hepner
- Department of Anesthesiology Perioperative and Pain Medicine Brigham and Women's Hospital Harvard Medical School, Boston, MA
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Urrea JK, Yela Muñoz IE, Cifuentes C. Valoración perioperatoria del paciente para cirugía no cardiaca. REVISTA COLOMBIANA DE CARDIOLOGÍA 2015. [DOI: 10.1016/j.rccar.2015.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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180
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Cram P, Lu X, Li Y. Bundled Payments for Elective Primary Total Knee Arthroplasty: An Analysis of Medicare Administrative Data. Geriatr Orthop Surg Rehabil 2015; 6:3-10. [PMID: 26246946 DOI: 10.1177/2151458514559832] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Bundled payments have been proposed as a mechanism for restraining health care spending for total knee arthroplasty (TKA), but empirical data are limited. We used Medicare data to examine variation in payments for TKA during a window extending 30 days before to 90 days after TKA for 167 186 patients who underwent elective primary TKA in 2009. Mean Medicare payment was US$23 656. We found that 2.5% of patients incurred payments of >US$50 000 (0.2% >US$100 000). Payments were lower for men and for non-Hispanic whites but higher for patients with greater comorbidity. Episode-of-care payment for primary TKA varies substantially depending upon patient demographics and comorbidity. To the extent that similar patients tend to be clustered within hospitals, bundled payments could inadvertently cause financial harm to certain health systems while rewarding others.
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Affiliation(s)
- Peter Cram
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada ; Division of General Internal Medicine, Mt Sinai/UHN Hospitals, Toronto, Canada ; Division of General Internal Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Xin Lu
- Division of General Internal Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Yue Li
- Department of Public Health Sciences, University of Rochester School of Medicine, Rochester, NY, USA
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182
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Ortiz VE, Kwo J. Obesity: physiologic changes and implications for preoperative management. BMC Anesthesiol 2015; 15:97. [PMID: 26141622 PMCID: PMC4491231 DOI: 10.1186/s12871-015-0079-8] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 06/24/2015] [Indexed: 02/08/2023] Open
Abstract
The proportion of patients defined as obese continues to grow in many westernized nations, particularly the United States (USA). This trend has shifted the perioperative management of obese patients into the realm of routine care. As obese patients present for all types of procedures, it is crucial for anesthesiologists, surgeons, internists, and perioperative health care providers alike to have a firm understanding of their altered multi-organ physiology in order to safely prepare the obese patient for an operation. A careful preoperative evaluation may also serve to identify risk factors for postoperative adverse events. Subsequently, preoperative measures may be implemented to mitigate these complications. In this manuscript we address the major considerations for the preoperative evaluation of the severely obese patient.
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Affiliation(s)
- Vilma E Ortiz
- Department of Anesthesia, Critical Care & Pain Medicine, Associate Anesthetist, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
| | - Jean Kwo
- Department of Anesthesia, Critical Care & Pain Medicine, Associate Anesthetist, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
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183
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Kirkham KR, Wijeysundera DN, Pendrith C, Ng R, Tu JV, Laupacis A, Schull MJ, Levinson W, Bhatia RS. Preoperative testing before low-risk surgical procedures. CMAJ 2015; 187:E349-E358. [PMID: 26032314 DOI: 10.1503/cmaj.150174] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND There is concern about increasing utilization of low-value health care services, including preoperative testing for low-risk surgical procedures. We investigated temporal trends, explanatory factors, and institutional and regional variation in the utilization of testing before low-risk procedures. METHODS For this retrospective cohort study, we accessed linked population-based administrative databases from Ontario, Canada. A cohort of 1 546 223 patients 18 years or older underwent a total of 2 224 070 low-risk procedures, including endoscopy and ophthalmologic surgery, from Apr. 1, 2008, to Mar. 31, 2013, at 137 institutions in 14 health regions. We used hierarchical logistic regression models to assess patient- and institution-level factors associated with electrocardiography (ECG), transthoracic echocardiography, cardiac stress test or chest radiography within 60 days before the procedure. RESULTS Endoscopy, ophthalmologic surgery and other low-risk procedures accounted for 40.1%, 34.2% and 25.7% of procedures, respectively. ECG and chest radiography were conducted before 31.0% (95% confidence interval [CI] 30.9%-31.1%) and 10.8% (95% CI 10.8%-10.8%) of procedures, respectively, whereas the rates of preoperative echocardiography and stress testing were 2.9% (95% CI 2.9%-2.9%) and 2.1% (95% CI 2.1%-2.1%), respectively. Significant variation was present across institutions, with the frequency of preoperative ECG ranging from 3.4% to 88.8%. Receipt of preoperative ECG and radiography were associated with older age (among patients 66-75 years of age, for ECG, adjusted odds ratio [OR] 18.3, 95% CI 17.6-19.0; for radiography, adjusted OR 2.9, 95% CI 2.8-3.0), preoperative anesthesia consultation (for ECG, adjusted OR 8.7, 95% CI 8.5-8.8; for radiography, adjusted OR 2.2, 95% CI 2.1-2.2) and preoperative medical consultation (for ECG, adjusted OR 6.8, 95% CI 6.7-6.9; for radiography, adjusted OR 3.6, 95% CI 3.5-3.6). The median ORs for receipt of preoperative ECG and radiography were 2.3 and 1.6, respectively. INTERPRETATION Despite guideline recommendations to limit testing before low-risk surgical procedures, preoperative ECG and chest radiography were performed frequently. Significant variation across institutions remained after adjustment for patient- and institution-level factors.
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Affiliation(s)
- Kyle R Kirkham
- Department of Anesthesia and Pain Management (Kirkham), Toronto Western Hospital, University of Toronto, Toronto, Ont.; Department of Anesthesia (Kirkham) and Institute for Health System Solutions and Virtual Care (Pendrith, Bhatia), Women's College Hospital, Toronto, Ont.; Li Ka Shing Knowledge Institute (Wijeysundera, Laupacis), St. Michael's Hospital, Toronto, Ont.; Department of Anesthesia and Pain Management (Wijeysundera), Toronto General Hospital, University of Toronto, Toronto, Ont.; Department of Medicine (Wijeysundera, Tu, Laupacis, Schull, Levinson), University of Toronto, Toronto, Ont.; Institute for Clinical Evaluative Sciences (Ng, Tu, Laupacis, Schull, Bhatia), Toronto, Ont.; Division of Cardiology (Tu), Sunnybrook Schulich Heart Centre, Toronto, Ont.; Sunnybrook Research Institute (Schull), Toronto, Ont.; Division of Cardiology (Bhatia), University Health Network, Toronto, Ont
| | - Duminda N Wijeysundera
- Department of Anesthesia and Pain Management (Kirkham), Toronto Western Hospital, University of Toronto, Toronto, Ont.; Department of Anesthesia (Kirkham) and Institute for Health System Solutions and Virtual Care (Pendrith, Bhatia), Women's College Hospital, Toronto, Ont.; Li Ka Shing Knowledge Institute (Wijeysundera, Laupacis), St. Michael's Hospital, Toronto, Ont.; Department of Anesthesia and Pain Management (Wijeysundera), Toronto General Hospital, University of Toronto, Toronto, Ont.; Department of Medicine (Wijeysundera, Tu, Laupacis, Schull, Levinson), University of Toronto, Toronto, Ont.; Institute for Clinical Evaluative Sciences (Ng, Tu, Laupacis, Schull, Bhatia), Toronto, Ont.; Division of Cardiology (Tu), Sunnybrook Schulich Heart Centre, Toronto, Ont.; Sunnybrook Research Institute (Schull), Toronto, Ont.; Division of Cardiology (Bhatia), University Health Network, Toronto, Ont
| | - Ciara Pendrith
- Department of Anesthesia and Pain Management (Kirkham), Toronto Western Hospital, University of Toronto, Toronto, Ont.; Department of Anesthesia (Kirkham) and Institute for Health System Solutions and Virtual Care (Pendrith, Bhatia), Women's College Hospital, Toronto, Ont.; Li Ka Shing Knowledge Institute (Wijeysundera, Laupacis), St. Michael's Hospital, Toronto, Ont.; Department of Anesthesia and Pain Management (Wijeysundera), Toronto General Hospital, University of Toronto, Toronto, Ont.; Department of Medicine (Wijeysundera, Tu, Laupacis, Schull, Levinson), University of Toronto, Toronto, Ont.; Institute for Clinical Evaluative Sciences (Ng, Tu, Laupacis, Schull, Bhatia), Toronto, Ont.; Division of Cardiology (Tu), Sunnybrook Schulich Heart Centre, Toronto, Ont.; Sunnybrook Research Institute (Schull), Toronto, Ont.; Division of Cardiology (Bhatia), University Health Network, Toronto, Ont
| | - Ryan Ng
- Department of Anesthesia and Pain Management (Kirkham), Toronto Western Hospital, University of Toronto, Toronto, Ont.; Department of Anesthesia (Kirkham) and Institute for Health System Solutions and Virtual Care (Pendrith, Bhatia), Women's College Hospital, Toronto, Ont.; Li Ka Shing Knowledge Institute (Wijeysundera, Laupacis), St. Michael's Hospital, Toronto, Ont.; Department of Anesthesia and Pain Management (Wijeysundera), Toronto General Hospital, University of Toronto, Toronto, Ont.; Department of Medicine (Wijeysundera, Tu, Laupacis, Schull, Levinson), University of Toronto, Toronto, Ont.; Institute for Clinical Evaluative Sciences (Ng, Tu, Laupacis, Schull, Bhatia), Toronto, Ont.; Division of Cardiology (Tu), Sunnybrook Schulich Heart Centre, Toronto, Ont.; Sunnybrook Research Institute (Schull), Toronto, Ont.; Division of Cardiology (Bhatia), University Health Network, Toronto, Ont
| | - Jack V Tu
- Department of Anesthesia and Pain Management (Kirkham), Toronto Western Hospital, University of Toronto, Toronto, Ont.; Department of Anesthesia (Kirkham) and Institute for Health System Solutions and Virtual Care (Pendrith, Bhatia), Women's College Hospital, Toronto, Ont.; Li Ka Shing Knowledge Institute (Wijeysundera, Laupacis), St. Michael's Hospital, Toronto, Ont.; Department of Anesthesia and Pain Management (Wijeysundera), Toronto General Hospital, University of Toronto, Toronto, Ont.; Department of Medicine (Wijeysundera, Tu, Laupacis, Schull, Levinson), University of Toronto, Toronto, Ont.; Institute for Clinical Evaluative Sciences (Ng, Tu, Laupacis, Schull, Bhatia), Toronto, Ont.; Division of Cardiology (Tu), Sunnybrook Schulich Heart Centre, Toronto, Ont.; Sunnybrook Research Institute (Schull), Toronto, Ont.; Division of Cardiology (Bhatia), University Health Network, Toronto, Ont
| | - Andreas Laupacis
- Department of Anesthesia and Pain Management (Kirkham), Toronto Western Hospital, University of Toronto, Toronto, Ont.; Department of Anesthesia (Kirkham) and Institute for Health System Solutions and Virtual Care (Pendrith, Bhatia), Women's College Hospital, Toronto, Ont.; Li Ka Shing Knowledge Institute (Wijeysundera, Laupacis), St. Michael's Hospital, Toronto, Ont.; Department of Anesthesia and Pain Management (Wijeysundera), Toronto General Hospital, University of Toronto, Toronto, Ont.; Department of Medicine (Wijeysundera, Tu, Laupacis, Schull, Levinson), University of Toronto, Toronto, Ont.; Institute for Clinical Evaluative Sciences (Ng, Tu, Laupacis, Schull, Bhatia), Toronto, Ont.; Division of Cardiology (Tu), Sunnybrook Schulich Heart Centre, Toronto, Ont.; Sunnybrook Research Institute (Schull), Toronto, Ont.; Division of Cardiology (Bhatia), University Health Network, Toronto, Ont
| | - Michael J Schull
- Department of Anesthesia and Pain Management (Kirkham), Toronto Western Hospital, University of Toronto, Toronto, Ont.; Department of Anesthesia (Kirkham) and Institute for Health System Solutions and Virtual Care (Pendrith, Bhatia), Women's College Hospital, Toronto, Ont.; Li Ka Shing Knowledge Institute (Wijeysundera, Laupacis), St. Michael's Hospital, Toronto, Ont.; Department of Anesthesia and Pain Management (Wijeysundera), Toronto General Hospital, University of Toronto, Toronto, Ont.; Department of Medicine (Wijeysundera, Tu, Laupacis, Schull, Levinson), University of Toronto, Toronto, Ont.; Institute for Clinical Evaluative Sciences (Ng, Tu, Laupacis, Schull, Bhatia), Toronto, Ont.; Division of Cardiology (Tu), Sunnybrook Schulich Heart Centre, Toronto, Ont.; Sunnybrook Research Institute (Schull), Toronto, Ont.; Division of Cardiology (Bhatia), University Health Network, Toronto, Ont
| | - Wendy Levinson
- Department of Anesthesia and Pain Management (Kirkham), Toronto Western Hospital, University of Toronto, Toronto, Ont.; Department of Anesthesia (Kirkham) and Institute for Health System Solutions and Virtual Care (Pendrith, Bhatia), Women's College Hospital, Toronto, Ont.; Li Ka Shing Knowledge Institute (Wijeysundera, Laupacis), St. Michael's Hospital, Toronto, Ont.; Department of Anesthesia and Pain Management (Wijeysundera), Toronto General Hospital, University of Toronto, Toronto, Ont.; Department of Medicine (Wijeysundera, Tu, Laupacis, Schull, Levinson), University of Toronto, Toronto, Ont.; Institute for Clinical Evaluative Sciences (Ng, Tu, Laupacis, Schull, Bhatia), Toronto, Ont.; Division of Cardiology (Tu), Sunnybrook Schulich Heart Centre, Toronto, Ont.; Sunnybrook Research Institute (Schull), Toronto, Ont.; Division of Cardiology (Bhatia), University Health Network, Toronto, Ont
| | - R Sacha Bhatia
- Department of Anesthesia and Pain Management (Kirkham), Toronto Western Hospital, University of Toronto, Toronto, Ont.; Department of Anesthesia (Kirkham) and Institute for Health System Solutions and Virtual Care (Pendrith, Bhatia), Women's College Hospital, Toronto, Ont.; Li Ka Shing Knowledge Institute (Wijeysundera, Laupacis), St. Michael's Hospital, Toronto, Ont.; Department of Anesthesia and Pain Management (Wijeysundera), Toronto General Hospital, University of Toronto, Toronto, Ont.; Department of Medicine (Wijeysundera, Tu, Laupacis, Schull, Levinson), University of Toronto, Toronto, Ont.; Institute for Clinical Evaluative Sciences (Ng, Tu, Laupacis, Schull, Bhatia), Toronto, Ont.; Division of Cardiology (Tu), Sunnybrook Schulich Heart Centre, Toronto, Ont.; Sunnybrook Research Institute (Schull), Toronto, Ont.; Division of Cardiology (Bhatia), University Health Network, Toronto, Ont.
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Hwang JW, Kim EK, Yang JH, Chang SA, Song YB, Hahn JY, Choi SH, Gwon HC, Lee SH, Kim SM, Choe YH, Oh JK, Choi JH. Assessment of Perioperative Cardiac Risk of Patients Undergoing Noncardiac Surgery Using Coronary Computed Tomographic Angiography. Circ Cardiovasc Imaging 2015; 8:CIRCIMAGING.114.002582. [DOI: 10.1161/circimaging.114.002582] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Ji-won Hwang
- From the Division of Cardiology, Department of Medicine (J.H., E.-K.K., J.-H.Y., S.-A.C., Y.B.S., J.-Y.H., S.H.C., H.-C.G., S.-H.L., J.-H.C.), Department of Emergency Medicine (J.-H.C.), and Department of Radiology (S.-M.K., Y.H.C.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; and Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN (J.K.O.)
| | - Eun-Kyung Kim
- From the Division of Cardiology, Department of Medicine (J.H., E.-K.K., J.-H.Y., S.-A.C., Y.B.S., J.-Y.H., S.H.C., H.-C.G., S.-H.L., J.-H.C.), Department of Emergency Medicine (J.-H.C.), and Department of Radiology (S.-M.K., Y.H.C.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; and Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN (J.K.O.)
| | - Jung-Hoon Yang
- From the Division of Cardiology, Department of Medicine (J.H., E.-K.K., J.-H.Y., S.-A.C., Y.B.S., J.-Y.H., S.H.C., H.-C.G., S.-H.L., J.-H.C.), Department of Emergency Medicine (J.-H.C.), and Department of Radiology (S.-M.K., Y.H.C.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; and Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN (J.K.O.)
| | - Sung-A Chang
- From the Division of Cardiology, Department of Medicine (J.H., E.-K.K., J.-H.Y., S.-A.C., Y.B.S., J.-Y.H., S.H.C., H.-C.G., S.-H.L., J.-H.C.), Department of Emergency Medicine (J.-H.C.), and Department of Radiology (S.-M.K., Y.H.C.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; and Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN (J.K.O.)
| | - Young Bin Song
- From the Division of Cardiology, Department of Medicine (J.H., E.-K.K., J.-H.Y., S.-A.C., Y.B.S., J.-Y.H., S.H.C., H.-C.G., S.-H.L., J.-H.C.), Department of Emergency Medicine (J.-H.C.), and Department of Radiology (S.-M.K., Y.H.C.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; and Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN (J.K.O.)
| | - Joo-Yong Hahn
- From the Division of Cardiology, Department of Medicine (J.H., E.-K.K., J.-H.Y., S.-A.C., Y.B.S., J.-Y.H., S.H.C., H.-C.G., S.-H.L., J.-H.C.), Department of Emergency Medicine (J.-H.C.), and Department of Radiology (S.-M.K., Y.H.C.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; and Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN (J.K.O.)
| | - Seung Hyuk Choi
- From the Division of Cardiology, Department of Medicine (J.H., E.-K.K., J.-H.Y., S.-A.C., Y.B.S., J.-Y.H., S.H.C., H.-C.G., S.-H.L., J.-H.C.), Department of Emergency Medicine (J.-H.C.), and Department of Radiology (S.-M.K., Y.H.C.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; and Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN (J.K.O.)
| | - Hyeon-Cheol Gwon
- From the Division of Cardiology, Department of Medicine (J.H., E.-K.K., J.-H.Y., S.-A.C., Y.B.S., J.-Y.H., S.H.C., H.-C.G., S.-H.L., J.-H.C.), Department of Emergency Medicine (J.-H.C.), and Department of Radiology (S.-M.K., Y.H.C.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; and Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN (J.K.O.)
| | - Sang-Hoon Lee
- From the Division of Cardiology, Department of Medicine (J.H., E.-K.K., J.-H.Y., S.-A.C., Y.B.S., J.-Y.H., S.H.C., H.-C.G., S.-H.L., J.-H.C.), Department of Emergency Medicine (J.-H.C.), and Department of Radiology (S.-M.K., Y.H.C.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; and Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN (J.K.O.)
| | - Sung-Mok Kim
- From the Division of Cardiology, Department of Medicine (J.H., E.-K.K., J.-H.Y., S.-A.C., Y.B.S., J.-Y.H., S.H.C., H.-C.G., S.-H.L., J.-H.C.), Department of Emergency Medicine (J.-H.C.), and Department of Radiology (S.-M.K., Y.H.C.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; and Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN (J.K.O.)
| | - Yeon Hyeon Choe
- From the Division of Cardiology, Department of Medicine (J.H., E.-K.K., J.-H.Y., S.-A.C., Y.B.S., J.-Y.H., S.H.C., H.-C.G., S.-H.L., J.-H.C.), Department of Emergency Medicine (J.-H.C.), and Department of Radiology (S.-M.K., Y.H.C.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; and Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN (J.K.O.)
| | - Jae K. Oh
- From the Division of Cardiology, Department of Medicine (J.H., E.-K.K., J.-H.Y., S.-A.C., Y.B.S., J.-Y.H., S.H.C., H.-C.G., S.-H.L., J.-H.C.), Department of Emergency Medicine (J.-H.C.), and Department of Radiology (S.-M.K., Y.H.C.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; and Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN (J.K.O.)
| | - Jin-Ho Choi
- From the Division of Cardiology, Department of Medicine (J.H., E.-K.K., J.-H.Y., S.-A.C., Y.B.S., J.-Y.H., S.H.C., H.-C.G., S.-H.L., J.-H.C.), Department of Emergency Medicine (J.-H.C.), and Department of Radiology (S.-M.K., Y.H.C.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; and Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN (J.K.O.)
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LaBounty TM, Eagle KA. Coronary computed tomographic angiography for preoperative risk: improved area under curve is not enough. Circ Cardiovasc Imaging 2015; 8:CIRCIMAGING.115.003157. [PMID: 25711277 DOI: 10.1161/circimaging.115.003157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Troy M LaBounty
- From the Department of Medicine, University of Michigan Health System, Ann Arbor.
| | - Kim A Eagle
- From the Department of Medicine, University of Michigan Health System, Ann Arbor
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Fleisher LA, Fleischmann KE, Auerbach AD, Barnason SA, Beckman JA, Bozkurt B, Davila-Roman VG, Gerhard-Herman MD, Holly TA, Kane GC, Marine JE, Nelson MT, Spencer CC, Thompson A, Ting HH, Uretsky BF, Wijeysundera DN. 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. Developed in collaboration with the American College of Surgeons, American Society of Anesthesiologists, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Anesthesiologists, and Society of Vascular Medicine Endorsed by the Society of Hospital Medicine. J Nucl Cardiol 2015; 22:162-215. [PMID: 25523415 DOI: 10.1007/s12350-014-0025-z] [Citation(s) in RCA: 110] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Fleisher LA, Fleischmann KE, Auerbach AD, Barnason SA, Beckman JA, Bozkurt B, Davila-Roman VG, Gerhard-Herman MD, Holly TA, Kane GC, Marine JE, Nelson MT, Spencer CC, Thompson A, Ting HH, Uretsky BF, Wijeysundera DN. 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; 130:2215-45. [PMID: 25085962 DOI: 10.1161/cir.0000000000000105] [Citation(s) in RCA: 468] [Impact Index Per Article: 46.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Anderson JL, Antman EM, Harold JG, Jessup M, O'Gara PT, Pinto FJ, Vardas PE, Zamorano JL. Clinical Practice Guidelines on Perioperative Cardiovascular Evaluation: collaborative efforts among the American College of Cardiology, the American Heart Association, and the European Society of Cardiology. Eur Heart J 2014; 35:2342-3. [DOI: 10.1093/eurheartj/ehu295] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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