The inductor role of cardiac consultation in the pre-anesthetic evaluation of asymptomatic patients submitted to non-cardiac minor and intermediate-risk surgery: a cross-sectional study
O papel indutor da interconsulta cardiológica em avaliações préanestésicas de pacientes assintomáticos submetidos a cirurgias nãocardíacas de baixo e médio portes: um estudo transversal.
Antonio Carlos Cerqueira Oliveira Paulo Adriano Schwingel Lucas Archanjo dos Santos Luis Cláudio Lemos Correia
Abstract
Introduction
Asymptomatic patients with moderate functional capacity do not require Coronary Artery Disease (CAD) workup in the preoperative period of non-cardiac surgeries, especially when scheduled for minor and intermediate-risk surgeries. The workup is inappropriate because it promotes over diagnosing and pointless treatments. Moreover, those patients usually undergo cardiology assessment, in addition to pre-anesthetic evaluation.
Objective
Investigate the role of cardiology consultation as mediator in inappropriate assessment of CAD for preoperative of non-cardiac surgeries.
Method
Retrospective study performed in a private anesthesia service using medical charts of asymptomatic patients with a history of controlled systemic disease and moderate functional capacity, submitted to pre-anesthetic consultation for minor and intermediate risk surgeries. Cardiology consultations were identified by the presence of a consultation report by a cardiologist. CAD workup was defined as undergoing cardiac stress tests.
Results
We included 390 medical charts of patients with mean age of 48.6 ± 15.4 years, 67% women and 69% intermediate risk surgeries. CAD workup was infrequent and performed in 3.9% of patients. Besides, pre-anesthetic evaluation, 93 (24%) patients had a cardiology consultation. Among those patients, 15.1% were submitted to CAD workup, compared to 0.34% of patients without cardiology assessment (p < 0.001; RR = 4.4; 95% CI: 3.5–5.6).
Conclusions
Inappropriate testing for CAD investigation is infrequent for asymptomatic individuals submitted to minor and intermediate risk surgeries. However, cardiology consultation increases substantially the likelihood of a patient undergoing CAD workup, suggesting that, unlike the anesthesiologist, the cardiologist is a major mediator of this kind of management.
Keywords
Resumo
Justificativa: Pacientes assintomáticos com capacidade funcional moderada não têm indicação de pesquisa de doença arterial coronariana (DAC) no pré-operatório de cirurgias não cardíacas, especialmente de pequeno ou médio portes. Essa pesquisa é inapropriada por promover sobrediagnóstico e tratamentos fúteis. Ademais, esses pacientes eventualmente passam por avaliação cardiológica além da pré-anestésica. Objetivo: Explorar o papel da consulta cardiológica como mediador de pesquisa inapropriada de DAC em pré-operatório de cirurgias não cardíacas. Método: Estudo retrospectivo realizado em serviço de anestesiologia privado com prontuários de pacientes assintomáticos, sem histórico de doenças sistêmicas descompensadas e capacidade funcional moderada, submetidos a consulta pré-anestésica para cirurgias de pequeno e médio portes. Consulta cardiológica foi identificada pela presença de relatório de interconsulta realizada por cardiologista. Pesquisa de DAC foi definida pela execução de testes de estresse cardíaco. Resultados: Foram incluídos 390 prontuários, idade 48,6±15,4 anos, 67% mulheres e 69% cirurgias de médio porte. Pesquisa de DAC foi infrequente, realizada em 3,9% dos pacientes. Além da avaliação pré-anestésica, consulta cardiológica foi realizada em 93 (24%) pacientes. Dentro desses pacientes 15,1% foram submetidos a pesquisa de DAC, comparados aos 0,34% nos pacientes sem avaliação cardiológica (P<0,001; RR:4,4 IC95%:3,5–5,6). Conclusões: Exames inapropriados para pesquisa de DAC são infrequentes na população de pessoas assintomáticas submetidas a cirurgias de pequeno a médio portes. No entanto, a presença de avaliação cardiológica aumenta substancialmente a probabilidade do paciente se submeter a este tipo de exame, sugerindo que, diferente do anestesiologista, o cardiologista é um importante mediador deste tipo de conduta.
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References
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