Preoperative evaluation of patients with cardiovascular disease for noncardiac surgery

Abstract

Objective: Preoperative evaluation of the patients with cardiac problems who will undergo noncardiac surgery is crucial. The aim of our study is to investigate the relationship between cardiac risk determined by the American Society of Anesthesiologists (ASA) classification, Goldman scoring system, and the cardiology consultation, and the perioperative mortality and morbidity. Material and Method:Five hundred patients undergoing noncardiac surgery for whom cardiology consultation requested were studied prospectively. The relationship between the patients' ASA classes, Goldman scores, cardiac risks, comorbidities, operation types, preoperative cardiac symptoms, and perioperative morbidity and mortality was assessed. Results:The mean age in the group with morbidity (69.3±10.6 years) was significantly higher than that in the group without morbidity (64.0±12.1 years) (p<0.001). There was no perioperative mortality while in 354 (70.8%) of 500 patients cardiovascular complications developed.While a significant difference between operation type of both groups was observed (p=0.001), preoperative hypertension was more frequently seen in the morbidity group (p=0.007). Preoperative ASA classes (p=0.016), Goldman scores (p<0.001), and cardiac risks of patients (p=0.039) were significantly different between the groups. Logistic regression analysis was applied, and only age, hypertension, and operation type were found to be risk factors for perioperative morbidity. Conclusion:We believe that ASA classification, Goldman Cardiac Risk Index, and cardiac risk determined by the cardiologists can affect the patients' perioperative management . Besides use of risk indices and algorithms can reduce the requirement for consultation and request for unnecessary laboratory or imaging tests and can prevent unnecessary cancellation or delaying of the surgery. ÖZ Nonkardiyak Cerrahi Geçirecek Kardiyovasküler Hastalığı Olan Hastaların Preoperatif DeğerlendirilmesiAmaç: Nonkardiyak cerrahi geçirecek kardiyak sorunlu hastaların preoperatif değerlendirmesi oldukça kritiktir. Çalışmamızın amacı, Amerikan Anestezistler Derneği (ASA) sınıflaması, Goldman skorlama sistemi ve kardiyoloji konsültasyonu ile belirlenen kardiyak risk ile perioperative mortalite ve morbidite arasındaki ilişkinin araştırılmasıdır. Gereç ve Yöntem:Nonkardiyak cerrahi geçirecek, kardiyoloji konsültasyonu istenen 500 hasta prospektif olarak çalışmaya alındı. Hastaların ASA sınıfları, Goldman skorları, kardiyak riskleri, komorbiditeleri, operasyon tipleri, preoperative kardiyak semptomları ile perioperative mortalite ve morbidite arasındaki ilişki değerlendirildi.Bulgular: Morbidite gelişen grupta ortalama yaş (69.3±10.6) morbidite gelişmeyen gruba göre (64.0±12.1) anlamlı olarak yüksekti (p<0.001). Çalışmamızda perioperative mortalite gözlenmezken, 500 hastanın 354 (%70,8) ünde kardiyovasküler komplikasyon gelişti. Ameliyat tipi açısından iki grup arasında anlamlı farklılık gözlenirken (p=0.001), preoperatif hipertansiyon varlığı morbidite gelişen grupta daha sıktı (p=0.00...