Groot M W, Spronk A, Hoeks S E, Stolker R J, van Lier F
Department of Anesthesiology, Erasmus University Medical Center, Rotterdam, The Netherlands.
Neth Heart J. 2017 Nov;25(11):629-633. doi: 10.1007/s12471-017-1004-1.
The cardiologist is regularly consulted preoperatively by anaesthesiologists. However, insights into the efficiency and usefulness of these consultations are unclear.
This is a retrospective study of 24,174 preoperatively screened patients ≥18 years scheduled for elective non-cardiac surgery, which resulted in 273 (1%) referrals to the cardiologist for further preoperative evaluation. Medical charts were reviewed for patient characteristics, main reason for referring, requested diagnostic tests, interventions, adjustment in medical therapy, 30-day mortality and major adverse cardiac events.
The most common reason for consultation was the evaluation of a cardiac murmur (95 patients, 35%). In 167 (61%) patients, no change in therapy was initiated by the cardiologist. Six consultations (2%) led to invasive interventions (electrical cardioversion, percutaneous coronary intervention or coronary artery bypass surgery). On average, consultation delayed clearance for surgery by two weeks.
In most patients referred to the cardiologist after being screened at an outpatient anaesthesiology clinic, echocardiography is performed for ruling out specific conditions and to be sure that no further improvement can be made in the patient's health. In the majority, no change in therapy was initiated by the cardiologist. A more careful consideration about the potential benefits of consulting must be made for every patient.
麻醉医生术前经常会向心脏病专家咨询。然而，对于这些咨询的效率和实用性尚不清楚。
这是一项对24174例计划进行择期非心脏手术、年龄≥18岁且术前经过筛查的患者的回顾性研究，其中有273例（1%）被转诊至心脏病专家处进行进一步的术前评估。对病历进行了审查，以了解患者特征、转诊的主要原因、要求的诊断检查、干预措施、药物治疗调整、30天死亡率和主要不良心脏事件。
最常见的咨询原因是对心脏杂音的评估（95例患者，35%）。在167例（61%）患者中，心脏病专家未启动治疗方案的改变。6次咨询（2%）导致了有创干预（电复律、经皮冠状动脉介入治疗或冠状动脉旁路移植术）。平均而言，咨询使手术许可延迟了两周。
在门诊麻醉科筛查后转诊至心脏病专家处的大多数患者中，会进行超声心动图检查以排除特定疾病，并确保患者健康状况无法进一步改善。大多数情况下，心脏病专家未启动治疗方案的改变。对于每一位患者，都必须更仔细地考虑咨询的潜在益处。
