Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2020.10.020
Brazilian Journal of Anesthesiology
Clinical Research

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

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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

Preoperative assessment;  Coronary disease;  Overdiagnosis;  Inappropriate prescribing

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.

Palavras-chave

Avaliação préoperatória; doença coronária; sobrediagnóstico; uso inapropriado.

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