Cardiac Screening Before Noncardiac Surgery

Williams, Freddie M.; Bergin, James D.

doi:10.1016/j.suc.2009.05.001

Cited by 22 publications

(11 citation statements)

References 72 publications

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“…All noncardiac surgery candidates require preoperative screening with a focus on detecting significant CAD [10] . The evidence for and against particular tests has been subjected to extensive review [2] .…”

Section: Transplantationmentioning

confidence: 99%

Screening for cardiovascular disease before kidney transplantation

Palepu

Prasad

2015

WJT

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Pre-kidney transplant cardiac screening has garnered particular attention from guideline committees as an approach to improving post-transplant success. Screening serves two major purposes: To more accurately inform transplant candidates of their risk for a cardiac event before and after the transplant, thereby informing decisions about proceeding with transplantation, and to guide pre-transplant management so that posttransplant success can be maximized. Transplant candidates on dialysis are more likely to be screened for coronary artery disease than those not being considered for transplantation. Thorough history and physical examination taking, resting electrocardiography and echocardiography, exercise stress testing, myocardial perfusion scintigraphy, dobutamine stress echocardiography, cardiac computed tomography, cardiac biomarker measurement, and cardiac magnetic resonance imaging all play contributory roles towards screening for cardiovascular disease before kidney transplantation. In this review, the importance of each of these screening procedures for both coronary artery disease and other forms of cardiac disease are discussed.

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Section: Transplantationmentioning

confidence: 99%

Screening for cardiovascular disease before kidney transplantation

Palepu

Prasad

2015

WJT

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“…Increasing knowledge and use of the ACC/AHA guideline by practitioners can further assist in determining if additional cardiac testing is necessary, potentially decreasing adverse events and treatment costs (Arora et al, 2011;Sweitzer, 2008;Williams & Bergin, 2009). Arora et al (2011) noted the adherence to published screening guidelines significantly reduces the cost of patient care.…”

Section: Interventionmentioning

confidence: 99%

“…Because both of these organizations Cardiac complications are a major cause of perioperative morbidity and mortality. Half of the mortalities for patients undergoing noncardiac surgeries are related to cardiovascular complications, with most of these patients being of advanced age or having vascular disease (Arora, Velanovich, & Alarcon, 2011;DeHert, 2009;Priebe, 2011;Williams & Bergin, 2009). There are approximately 23 million veterans with an average age of 64 years in the United States (National Center for Veterans Analysis and Statistics, 2013).…”

mentioning

confidence: 99%

Improving Preoperative Cardiac Assessment Efficiency by Using the American College of Cardiology/American Heart Association Guidelines: A Quality Improvement Project

et al. 2015

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Background: Patients undergoing noncardiac surgery can experience cardiac complications, which are a major cause of morbidity and mortality in the perioperative period. The goal of this quality improvement (QI) project was to standardize the preoperative assessment process and improve patient-centered care by implementing evidence-based practice guidelines for electrocardiogram (ECG) recommendations prior to noncardiac surgery. Methods: Three steps were used to implement the American College of Cardiology/American Heart Association (ACC/AHA) recommendation for ECG to reduce variance in practice and decrease surgical cancellations. A pre-and postdesign was used to evaluate 2 outcomes: decreased surgical cancellations for lack of a current ECG and surgical loss opportunity cost. All data were retrospectively collected for 60 days during the pre-and postperiods. Results: Evidence-based, preoperative ECG recommendations were implemented in the electronic medical record (EMR). Overall, ECG guideline adherence increased from 50% to 66% (x 2 5 2.19, p 5 .139) postimplementation. Surgical cancellations because of unmet ECG requirements were reduced from 50% to 34% (x 2 5 2.19, p 5 .139) post-EMR guideline implementation. There was no statistical difference in the cost associated with loss surgical opportunity minutes between the periods (t 5 0. 79, p 5 .43, 95% CI [26.96, 16.24]). Discussion: We successfully implemented an evidence-based guideline recommending specific preoperative ECG requirements within a busy Veterans Administration hospital. This project stimulated ongoing dialogue between the disciplines with positive trends in decreased surgical cancellations.

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“…from 30 days before to 30 days after surgery, although the most common time of onset is within the first 72 postoperative hours [12][13][14][15][16] .…”

Section: Introductionmentioning

confidence: 99%

“…In view of these considerations, the objective of this study was to evaluate the incidence of AMI among patients with critical ischemia who had undergone revascularization of the lower extremities [15][16][17][18][19] .…”

Section: Introductionmentioning

confidence: 99%

Acute myocardial infarctation in patients with critical ischemia underwent lower limb revascularization

et al. 2013

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Background: Atherosclerosis is the main cause of peripheral artery occlusive disease (PAOD) of the lower limbs. Patients with PAOD often also have obstructive atherosclerosis in other arterial sites, mainly the coronary arteries. This means that patients who undergo infrainguinal bypass to treat critical ischemia have a higher risk of AMI. There are, however, few reports in the literature that have assessed this risk properly. Objective: The aim of this study was to determine the incidence of acute myocardial infarction in patients who underwent infrainguinal bypass to treat critical ischemia of the lower limbs caused by PAOD. Material and Methods: A total of 64 patients who underwent 82 infrainguinal bypass operations, from February 2011 to July 2012 were studied. All patients had electrocardiograms and troponin I blood assays during the postoperative period (within 72 hours). Results: There were abnormal ECG findings and elevated blood troponin I levels suggestive of AMI in five (6%) of the 82 operations performed. All five had conventional surgery. The incidence of AMI as a proportion of the 52 conventional surgery cases was 9.6%. Two patients died. Conclusion: There was a 6% AMI incidence among patients who underwent infrainguinal bypass due to PAOD. Considering only cases operated using conventional surgery, the incidence of AMI was 9.6%.

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Cardiac Screening Before Noncardiac Surgery

Cited by 22 publications

References 72 publications

Screening for cardiovascular disease before kidney transplantation

Screening for cardiovascular disease before kidney transplantation

Improving Preoperative Cardiac Assessment Efficiency by Using the American College of Cardiology/American Heart Association Guidelines: A Quality Improvement Project

Acute myocardial infarctation in patients with critical ischemia underwent lower limb revascularization

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