Preoperative Cardiac Risk Assessment for Noncardiac Surgery: Defining Costs and Risks

Augoustides, John; Neuman, Mark D.; Al-Ghofaily, Lourdes; Silvay, George

doi:10.1053/j.jvca.2012.11.020

Cited by 10 publications

(6 citation statements)

References 36 publications

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“…For patients with multiple risk factors, these consultations can be plentiful and significant. Therefore, risk calculators to identify low-risk patients who would not likely benefit from excessive consultations and high risk patients who would benefit from cardiac optimization could be implemented as both a cost-saving measure and a patient aid [ 94 ]. Postoperative costs include hospital stay and pharmacy charges, with complications and prolonged postoperative length of stay contributing substantially to cost increase and variability [ 92 ].…”

Section: Discussionmentioning

confidence: 99%

Bladder Cancer Recovery Pathways: A Systematic Review

Maloney

Parker

Cookson

et al. 2017

BLC

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Background:Enhanced recovery pathways, also known as fast-track protocols, have been adopted since the early 2000s by various surgical specialties with the goal of improving patient outcomes and reducing the cost burden of major surgery on the health care system.Objective:To review the scientific literature on the origin of enhanced recovery pathways, track the contemporary utilization of such practices for patients undergoing radical cystectomy, and analyze the available data regarding their effect on morbidity, mortality, and treatment cost.Methods:A literature search of multiple electronic databases was undertaken. Manuscripts including patients undergoing radical cystectomy were chosen based on predefined criteria with an emphasis on randomized controlled trials and cohort studies. Strength of evidence for each study that met inclusion criteria was assessed based on the risk of bias, consistency, directness, and precision.Results:Database searches resulted in 1,236 potentially relevant articles. A total of 485 articles were selected for full-text dual review and 106 studies in 52 publications met the inclusion criteria.Conclusion:The utilization of enhanced recovery pathways with the goal of improving overall patient morbidity and mortality is well supported in the literature, however standardization of implementation and adherence across institutions is lacking, and their direct efficacy on reducing preventable treatment related expenditures is unconfirmed.

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Section: Discussionmentioning

confidence: 99%

Bladder Cancer Recovery Pathways: A Systematic Review

Maloney

Parker

Cookson

et al. 2017

BLC

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“…Perioperative acute coronary syndrome is difficult to be detected during general anesthesia. Instead of classical physical symptoms such as chest pain and dyspnea, ST segment changes on ECG and an elevation in serum cardiac enzymes levels such as troponin-I are considered to be useful measures [ 4 , 5 ]. In the present case, ST depression on ECG and marked elevation of serum troponin-I and CK-MB levels were detected, suggesting acute coronary syndrome.…”

Section: Discussionmentioning

confidence: 99%

Sudden cardiovascular collapse caused by severe anaphylaxis after cisatracurium use: a case report

Yoon

Bang

Seo

et al. 2014

Korean J Anesthesiol

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Kounis syndrome is an acute coronary syndrome concurrently occurs with allergic or hypersensitivity reactions. In patient with this syndrome, inflammatory mediators released due to an allergic reaction implicate to induce coronary artery spasm and atheromatous plaque rupture. We describe a patient with coronary artery disease who developed acute perioperative myocardial infarction leading to cardiac arrest after the anaphylactic reaction to cisatracurium, which led to a suspicion of Kounis syndrome. Anesthesiologists should be aware that anaphylaxis or allergic reactions can progress to acute coronary syndrome, thereby significantly change the course of the disease.

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“…Despite current guidelines that provide algorithms for preoperative testing, the efficacy of these evaluations is unclear. Multiple reports have demonstrated overutilisation of preoperative testing,1–6 yet few studies have compared the utilisation of preoperative testing and outcomes between cardiologists and non-specialists. Recent data have suggested that consultation with a cardiologist for preoperative evaluation before intermediate-risk surgery does not affect adverse cardiovascular event rates 7.…”

Section: Introductionmentioning

confidence: 99%

Cost conscious care: preoperative evaluation by a cardiologist prior to low-risk procedures

et al. 2019

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BackgroundPreoperative testing before low-risk procedures remains overutilised. Few studies have looked at factors leading to increased testing. We hypothesised that consultation to a cardiologist prior to a low-risk procedure leads to increased cardiac testing.Methods and results907 consecutive patients who underwent inpatient endoscopy/colonoscopy at a single academic centre were identified. Of those patients, 79 patients (8.7%) received preoperative consultation from a board certified cardiologist. 158 control patients who did not receive consultation from a cardiologist were matched by age and gender. Clinical and financial data were obtained from chart review and hospital billing. Logistic and linear regression models were constructed to compare the groups. Patients evaluated by a cardiologist were more likely to receive preoperative testing than patients who did not undergo evaluation with a cardiologist (OR 47.5, (95% CI 6.49 to 347.65). Specifically, patients seen by a cardiologist received more echocardiograms (60.8% vs 22.2%, p<0.0001) and 12-lead electrocardiograms (98.7% vs 54.4%, p<0.0001). There was a higher rate of ischaemic evaluations in the group evaluated by a cardiologist, but those differences did not achieve statistical significance. Testing led to longer length of stay (4.35 vs 3.46 days, p=0.0032) in the cohort evaluated by a cardiologist driven primarily by delay to procedure of 0.76 days (3.14 vs 2.38 days, p=0.001). Estimated costs resulting from the longer length of stay and increased testing was $10 624 per patient. There were zero major adverse cardiac events in either group.ConclusionPreoperative consultation to a cardiologist before a low-risk procedure is associated with more preoperative testing. This preoperative testing increases length of stay and cost without affecting outcomes.

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Preoperative Cardiac Risk Assessment for Noncardiac Surgery: Defining Costs and Risks

Cited by 10 publications

References 36 publications

Bladder Cancer Recovery Pathways: A Systematic Review

Bladder Cancer Recovery Pathways: A Systematic Review

Sudden cardiovascular collapse caused by severe anaphylaxis after cisatracurium use: a case report

Cost conscious care: preoperative evaluation by a cardiologist prior to low-risk procedures

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