Aslanger Emre, Altun Ibrahim, Guz Goksel, Kiraslan Omer, Polat Nihat, Golcuk Ebru, Oflaz Huseyin
Department of Cardiology, Istanbul Faculty of Medicine, Istanbul University, Capa-Istanbul, Turkey.
Acta Cardiol. 2011 Aug;66(4):447-52. doi: 10.1080/ac.66.4.2126592.
Despite the availability of guidelines for preoperative cardiology consultations, their efficacy in real clinical practice remains unknown. Furthermore, there are concerns that overused cardiology consultations can lead to unnecessary investigations, prolonged hospital stays, and even cancellation of necessary surgery. In this retrospective study, we investigated: (i) the potential impact of the American Heart Association/American College of Cardiology algorithm and (ii) the potential of this algorithm for preventing unnecessary evaluation.
We examined the cardiology consultation requests for 712 patients scheduled for elective surgery. Our analysis included: (i) patient characteristics, (ii) abnormalities revealed by the consultant, (iii) impact of these abnormalities on clinical decision making and therapy modification.
The most common reason for consultation was 'pre-operative evaluation' (80.9%). Although our cardiologists revealed an abnormality in 67.8% and recommended further work up in 58.7% of our patients, they contributed to the clinical course in only 36.9%. Moreover, when the algorithm was applied to 'routine pre-operative evaluation' requests lacking a specific question, only 7.6% of these consultation requests required further investigation.
Preoperative cardiology consultation seems to be overused. Although the fear of missing important issues leads surgeons to use a decreased threshold for pre-operative consultation requests, such a non-specific manner of pre-operative consultation request causes unnecessary investigations and decreased cost-effectiveness. Furthermore, the detection of any clinical abnormality by cardiologists surprisingly adds little to clinical decision making.
尽管有术前心脏科会诊指南，但这些指南在实际临床实践中的效果仍然未知。此外，人们担心过度使用心脏科会诊会导致不必要的检查、延长住院时间，甚至取消必要的手术。在这项回顾性研究中，我们调查了：（i）美国心脏协会/美国心脏病学会算法的潜在影响，以及（ii）该算法预防不必要评估的潜力。
我们检查了712例计划进行择期手术患者的心脏科会诊请求。我们的分析包括：（i）患者特征，（ii）会诊医生发现的异常情况，（iii）这些异常情况对临床决策和治疗调整的影响。
会诊的最常见原因是“术前评估”（80.9%）。尽管我们的心脏病专家在67.8%的患者中发现了异常，并在58.7%的患者中建议进一步检查，但他们仅在36.9%的患者中对临床病程产生了影响。此外，当该算法应用于缺乏特定问题的“常规术前评估”请求时，这些会诊请求中只有7.6%需要进一步调查。
术前心脏科会诊似乎被过度使用。尽管担心遗漏重要问题导致外科医生降低术前会诊请求的阈值，但这种非特定方式的术前会诊请求会导致不必要的检查并降低成本效益。此外，心脏病专家检测到的任何临床异常对临床决策的影响出人意料地小。
