PERI-OPERATIVE CARDIAC RISK ASSESSMENT PRIOR TO NON-CARDIAC SURGERY IN ALBERTA

Abstract

Peri-operative myocardial injury following non-cardiac surgery has been demonstrated to affect more than 10% of individuals, with increased morbidity and mortality. In 2016 the Canadian Cardiovascular Society released guidelines for peri-operative cardiac risk assessment, which target the identification of this high-risk population, including the use of pre-operative BNP and post-operative Troponin measurements. Our objective was to assess uptake of these recommendations in the Province of Alberta. A retrospective cohort of all patients undergoing non-cardiac surgery in Alberta from 2013 to 2017 was created using linked provincial administrative databases. Inclusion criteria mirrored the Guideline recommendations for peri-operative cardiac screening: patients with a Revised Cardiac Risk Index (RCRI) score ≥ 1, ≥ 65 years of age, or ≥45 years of age with history of cardiovascular disease, with planned overnight hospital stay. A total of 59, 506 patients were included in the final dataset. Overall, the rate of peri-operative BNP screening was 6.8%, ranging from 4.1% to 30.1% when stratified by RCRI score. Prior to Guideline release (2013-2015) peri-operative BNP screening was 6.23% compared to 7.82% between 2016-2017. Of the 3 346 (82.6%) patients with an abnormal pre-operative BNP, only 33.2% were monitored with post-operative Troponin measurements. Similarly, rate of post-operative troponin screening in patients with an elevated BNP was 31.33% (2013-2015) compared to 36.11% between 2016-2017. Of the 3965 patients with evidence of troponin elevation in the post-operative period, following up with either a cardiologist/internist (HR 0.281; p < 0.001) and the initiation of a beta blocker (HR 0.527; p < 0.001) was associated with decreased six-month mortality. Patients without pre-operative BNP screening demonstrated a six-month mortality of 5.9%. Despite the publication of Canadian multidisciplinary peri-operative cardiac risk assessment guidelines, uptake of the recommendations for peri-operative screening in the Province of Alberta remains low. Continued efforts to facilitate and streamline peri-operative cardiac risk assessment are crucial to improve outcomes in this high-risk population.View Large Image Figure ViewerDownload Hi-res image Download (PPT)