Key result
Preoperative cardiology evaluation yields no mortality benefit over general practitioners while prolonging hospital stay.
Why the study?
Preoperative evaluation aims to reduce postoperative MACE and mortality in arterial surgery patients, but there is no standardized approach to performing it.
Does preoperative evaluation by cardiologists reduce mortality and MACE in patients undergoing arterial vascular surgery compared to general practitioners?
Cohort (n=281)
No
Does preoperative evaluation by cardiologists reduce mortality and MACE in patients undergoing arterial vascular surgery compared to general practitioners?
Absolute Event Rate: 8.8% vs 10.7%
p-value: p=0.609
Preoperative evaluation by cardiologists for arterial vascular surgery increases testing and hospital length of stay without improving postoperative mortality or MACE compared to evaluation by hospitalists.
Cardiologist preoperative evaluation was associated with longer stays and more testing without MACE or mortality benefit; leaves open optimal referral strategy in elective vascular surgery.
BACKGROUND: Patients with peripheral arterial disease have an increased risk of developing cardiovascular complications in the postoperative period of arterial surgeries known as Major Adverse Cardiac Events (MACE), which includes acute myocardial infarction, heart failure, malignant arrhythmias, and stroke. The preoperative evaluation aims to reduce mortality and the risk of MACE. However, there is no standardized approach to performing them. The aim of this study was to compare the preoperative evaluation conducted by general practitioners with those performed by cardiologists. METHODS: This is a retrospective analysis of medical records of patients who underwent elective arterial surgeries from January 2016 to December 2020 at a tertiary hospital in São Paulo, Brazil. The authors compared the preoperative evaluation of these patients according to the initial evaluator (general practitioners vs. cardiologists), assessing patients' clinical factors, mortality, postoperative MACE incidence, rate of requested non-invasive stratification tests, length of hospital stay, among others. RESULTS: 281 patients were evaluated: 169 assessed by cardiologists and 112 by general practitioners. Cardiologists requested more non-invasive stratification tests (40.8%) compared to general practitioners (9%) (p < 0.001), with no impact on mortality (8.8% versus 10.7%; p = 0.609) and postoperative MACE incidence (10.6% versus 6.2%; p = 0.209). The total length of hospital stay was longer in the cardiologist group (17.27 versus 11.79 days; p < 0.001). CONCLUSION: The increased request for exams didn't have a significant impact on mortality and postoperative MACE incidence, but prolonged the total length of hospital stay. Health managers should consider these findings and ensure appropriate utilization of human and financial resources.
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Magnani et al. (2024) conducted a cohort in Peripheral arterial disease requiring arterial vascular surgery (n=281). Preoperative evaluation by cardiologists vs. Preoperative evaluation by general practitioners (hospitalists) was evaluated on Mortality (p=0.609). Preoperative evaluation by cardiologists compared to general practitioners significantly increased the length of hospital stay (17.27 vs 11.79 days) and test requests, without significantly impacting mortality or postoperative MACE incidence.
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