Perioperative cardiac risk assessment by anesthesiology residents

Abstract

Major adverse cardiac events (MACE) occurring during non-cardiac surgery (NCS) are a common cause of morbidity and mortality. An individual preoperative MACE risk stratification during NCS based on the patient-specific risk factors and the surgical risk is highly recommended by learned societies. The aim of our study was to evaluate the perioperative management of cardiac risk in NCS by anesthesiology residents. We conducted a prospective, longitudinal and descriptive study. One hundred anesthesiology residents practicing their residency training in several Tunisian university hospital centers (UHC) were asked to take a survey inspired by The French RICARDO survey. A quarter of residents reported that they never conducted multidisciplinary team meetings (MDTMs) during the preoperative care and that there were no validated protocols elaborated with cardiologists of their departments. The majority (96,3%) requested an ECG according to the patient's age and 33% a resting Transthoracic Echocardiography (TTE) for coronary artery disease risk assessment. A ß-blocker was initiated by 44,4% of residents. Acetylsalicylic acid and clopidogrel were systematically stopped by respectively 7,4% and 51.9% of residents. Intraoperatively, the anesthetic technique was general anesthesia in 52% of cases versus locoregional anesthesia in 48% of cases. Postoperatively, 14,8% required troponins, ECG, continuous monitoring, and cardiologist follow-up. In the case of troponins elevation, 81,5% requested an ECG, and 59% involved cardiologists. Through our work, we found a discrepancy between the recommendations and the anesthetic practices. Better dissemination of guidelines and the development of local standardized protocols for CV risk assessment would be beneficial.