Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
Hospital Municipal da Vila Santa Catarina Dr. Gilson de Cássia Marques de Carvalho; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
Clinics (Sao Paulo). 2024 Jul 25;79:100445. doi: 10.1016/j.clinsp.2024.100445. eCollection 2024.
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.
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.
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).
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.
患有外周动脉疾病的患者在动脉手术的术后期间发生心血管并发症（即主要不良心脏事件，MACE）的风险增加，这些并发症包括急性心肌梗死、心力衰竭、恶性心律失常和中风。术前评估旨在降低死亡率和 MACE 风险。然而，目前还没有标准化的方法来进行这些评估。本研究的目的是比较全科医生和心脏病专家进行的术前评估。
这是对巴西圣保罗一家三级医院 2016 年 1 月至 2020 年 12 月期间接受择期动脉手术的患者的病历进行的回顾性分析。作者根据初始评估者（全科医生与心脏病专家）比较了这些患者的术前评估，评估了患者的临床因素、死亡率、术后 MACE 发生率、请求非侵入性分层测试的比率、住院时间长短等。
共评估了 281 例患者：169 例由心脏病专家评估，112 例由全科医生评估。与全科医生相比，心脏病专家请求进行更多的非侵入性分层测试（40.8%比 9%）（p < 0.001），但这对死亡率（8.8%比 10.7%；p = 0.609）和术后 MACE 发生率（10.6%比 6.2%；p = 0.209）没有影响。心脏病专家组的总住院时间较长（17.27 天比 11.79 天；p < 0.001）。
增加检查请求并未显著影响死亡率和术后 MACE 发生率，但延长了总住院时间。卫生管理人员应考虑到这些发现，并确保适当利用人力和财力资源。
