Azizi Paymon M, Wijeysundera Duminda N, Wijeysundera Harindra C, Austin Peter C, Jerath Angela, Han Lu, Koh Maria, Ko Dennis T
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
ICES, Toronto, Ontario, Canada.
CJC Open. 2021 Mar 26;3(7):904-912. doi: 10.1016/j.cjco.2021.03.002. eCollection 2021 Jul.
In 2017, the Canadian Cardiovascular Society (CCS) published guidelines recommending postoperative troponin surveillance in higher-risk patients having major noncardiac surgery. The objective of this study was to evaluate the proportion of major noncardiac surgery patients that would meet recommendations for troponin testing and to assess the rates of troponin testing before guideline adoption.
We conducted a retrospective observational study of patients age 40 to 105 undergoing a subset of major noncardiac surgeries that included orthopedics, gynecology, general, urology, vascular, and thoracic surgeries in Ontario, Canada from January 1, 2010 to December 31, 2017. The primary outcomes were the proportion of patients recommended for testing based on the guidelines and rates of troponin testing within 2 days of surgery.
We identified 257,704 patients who underwent noncardiac surgery. Mean age was 66.4 ± 11.9 years, and 12.4% underwent urgent surgery. Applying the CCS guidelines, 71.2% of elective surgery patients and 81.0% of urgent surgery patients would have met recommendations for postoperative troponin screening, whereas 10.8% and 27.1% received postoperative troponin testing, respectively. Most elective surgery patients met recommendations for testing based on the age criterion (54.9%), followed by diabetes (24.6%) and high-risk surgery (22.7%) criteria. Troponin testing varied substantially by types of surgery: highest for open abdominal aortic aneurisms and lowest for hysterectomies.
Based on the CCS guidelines, most patients undergoing the subset of surgeries assessed would have met recommendations for routine troponin testing. In contrast, routine troponin testing before guideline adoption was done infrequently in Ontario, with substantial variations based on the surgery type.
2017年，加拿大心血管学会（CCS）发布了指南，建议对接受重大非心脏手术的高危患者进行术后肌钙蛋白监测。本研究的目的是评估符合肌钙蛋白检测建议的重大非心脏手术患者的比例，并评估指南采用前肌钙蛋白检测的比率。
我们对2010年1月1日至2017年12月31日在加拿大安大略省接受包括骨科、妇科、普通外科、泌尿外科、血管外科和胸外科在内的部分重大非心脏手术的40至105岁患者进行了一项回顾性观察研究。主要结局是根据指南建议进行检测的患者比例以及术后2天内肌钙蛋白检测的比率。
我们确定了257,704例接受非心脏手术的患者。平均年龄为66.4±11.9岁，12.4%的患者接受了急诊手术。应用CCS指南，71.2%的择期手术患者和81.0%的急诊手术患者符合术后肌钙蛋白筛查建议，而分别有10.8%和27.1%的患者接受了术后肌钙蛋白检测。大多数择期手术患者符合基于年龄标准（54.9%）的检测建议，其次是糖尿病（24.6%）和高风险手术（22.7%）标准。肌钙蛋白检测因手术类型而异：腹主动脉瘤开放手术最高，子宫切除术最低。
根据CCS指南，大多数接受评估的手术患者符合常规肌钙蛋白检测建议。相比之下，在安大略省，指南采用前的常规肌钙蛋白检测很少进行，且因手术类型存在很大差异。
