Evaluation of the patient with cardiac disease undergoing noncardiac surgery: an update on the original AHA/ACC guidelines

Preoperative Cardiac Evaluation: When Should the Surgeon Consult the Cardiologist?

PURPOSE

We compiled a manual aimed at reducing preoperative cardiac assessment costs and defining the roles of surgeons and cardiologists. We tested prospectively and retrospectively if this manual achieved these goals.

METHODS

Using the Guidelines for Perioperative Cardiovascular Evaluation for Noncardiac Surgery of the American College of Cardiology (ACC) / American Heart Association (AHA), and other articles as a reference, we compiled the Jichi Medical School Hospital (JMSH) Manual in September 2002. This manual contains a novel checklist and flowcharts and includes all past and present cardiac disorders, complications, abnormalities in electrocardiograms (ECGs) and chest X-rays, and evaluation of daily activity. Using this manual, we prospectively studied 1087 surgical candidates from September 2002 to August 2003, and retrospectively analyzed 927 surgical candidates from September 2001 to August 2002.

RESULTS

In the prospective study, 39 (3.6%) patients were deemed to require further cardiac assessment and 4 (0.37%) suffered postoperative complications. In the retrospective study, 108 (11.7%) were deemed to require further cardiac assessment and 20 (2.2%) suffered postoperative complications. Using this manual reduced preoperative cardiac examination costs by 1323,600 Japanese yen, representing a 70.5% reduction.

CONCLUSIONS

The JMSH Manual defines the roles of surgeons and cardiologists and is useful for assessing preoperative cardiac function and surgical risks. This manual dramatically reduced the costs associated with preoperative cardiac examinations.