Atar Funda, Özkan Sipahioğlu Fatma, Keskin Gülsen, Dönmez Aslı
University of Health Sciences Turkey, Etlik City Hospital, Clinic of Anaesthesiology and Reanimation, Ankara, Turkey.
Turk J Anaesthesiol Reanim. 2023 Dec 27;51(6):485-490. doi: 10.4274/TJAR.2023.231464.
Cardiologists are the most frequently consulted specialists during pre-operative evaluations. However, unnecessary cardiology consultations (CC) can increase cardiologists' workload without impacting anaesthesia practice, resulting in delayed surgeries and additional financial burdens. We hypothesize that using Gupta during the preoperative period can reduce these adverse effects.
This prospective study included patients scheduled for elective noncardiac, nonvascular surgeries who underwent pre-operative assessment. Patients who had no specific risk index used for preoperative cardiac risk evaluation were classified as Group I, and those evaluated using the Gupta scale were classified as Group II. The study compared preoperative CC, diagnostic tests, surgical delays, major adverse cardiac event (MACE), length of hospital stay and intensive care unit (ICU) stay, mortality, and costs.
A total of 898 patients were included in the study, with 487 in Group I and 411 in Group II. The Gupta group reduced the demand for preoperative CC (P<0.001) and preoperative non-invasive diagnostic testing (n = 107, 21.9% vs. n = 36, 8.75%). The time from the anaesthesiology outpatient clinic to surgery was 15 days in Group I and 14 days in Group II (=0.132). The length of ICU stay was higher in Group I (=0.019). MACE was 15 patients (3.08%) in Group I and 9 patients (2.19%) in Group II (=0.076). The cost of patients in Group I was higher than that in Group II (=0.019).
Using Gupta in preoperative evaluation may reduce unnecessary preoperative resource usage, surgical delays, ICU hospitalization rates, additional costs, and mortality.
在术前评估期间，心脏病专家是最常被咨询的专科医生。然而，不必要的心脏病学会诊（CC）会增加心脏病专家的工作量，却不会影响麻醉操作，从而导致手术延迟和额外的经济负担。我们假设在术前使用古普塔（Gupta）方法可以减少这些不良影响。
这项前瞻性研究纳入了计划进行择期非心脏、非血管手术且接受术前评估的患者。没有用于术前心脏风险评估的特定风险指数的患者被归类为第一组，使用古普塔量表进行评估的患者被归类为第二组。该研究比较了术前CC、诊断检查、手术延迟、主要不良心脏事件（MACE）、住院时间和重症监护病房（ICU）住院时间、死亡率及费用。
该研究共纳入898例患者，其中第一组487例，第二组411例。古普塔组减少了术前CC的需求（P<0.001）以及术前非侵入性诊断检查（第一组107例，21.9%；第二组36例，8.75%）。从麻醉门诊到手术的时间，第一组为15天，第二组为14天（P=0.132）。第一组的ICU住院时间更长（P=0.019）。第一组发生MACE的有15例患者（3.08%），第二组有9例患者（2.19%）（P=0.076）。第一组患者的费用高于第二组（P=0.019）。
在术前评估中使用古普塔方法可能会减少不必要的术前资源使用、手术延迟、ICU住院率、额外费用和死亡率。
