Abstract
BackgroundAn elevated cardiac troponin level after noncardiac surgery is associated with both morbidity and mortality. Guidelines suggest routine troponin monitoring in high-risk patients. We implemented a dedicated anesthesia team to conduct follow-up on patients with postoperative troponin elevation. We hypothesized that these visits would facilitate early detection of complications. Therefore, the aim of this study was to evaluate the effect of postoperative visits by dedicated anesthesiologists on early detection of complications and care utility.MethodsThis retrospective observational study included patients aged ≥ 60 years with an elevated troponin within the first 3 days after noncardiac surgery. Troponin elevation was detected by routine biomarker monitoring. The primary outcome was early detected myocardial infarctions by the dedicated anesthesiologist. Other outcomes were overall detected complications, additional diagnostic tests and treatment advised by the anesthesiologist, consultation of another medical specialist, and advised postoperative follow-up at the outpatient cardiac clinic within 1 week after surgery.ResultsOf the 811 patients, 509 (63%) received a postoperative consultation by the anesthesiologist. Anesthesiologists were involved in the early detection of 59% of all myocardial infarctions and in 12% of all complications. Besides cardiac ischemia, patients were also often diagnosed with noncardiac complications, including respiratory failure (8.9%), pneumonia (13.2%), and acute kidney injury (17.5%) within 1 week after surgery. In 75% of patients, anesthesiologists ordered additional diagnostics, most frequently existing of electrocardiograms and additional cardiac enzyme testing. Additionally, change in treatment was advised, most often a medication change, in 16% of patients.ConclusionsStandard consultation of a dedicated anesthesiologist resulted in an early detection of 59% of all myocardial infarctions and involved a change in treatment in a considerable number of patients with postoperative troponin elevation. Whether this may improve patient outcomes remains to be elucidated.
Highlights
An increased serum cardiac troponin level, as a marker for postoperative myocardial injury, has been shown to be an independent predictor of morbidity and mortality within the first year after non-cardiac surgery (Devereaux et al 2017; Levy et al 2011; van Waes et al 2016; van Waes et al 2013)
Standard consultation of a dedicated anesthesiologist resulted in an early detection of 59% of all myocardial infarctions and involved a change in treatment in a considerable number of patients with postoperative troponin elevation
Patients admitted immediately after the procedure at the intensive care unit (ICU) or the cardiac care unit (CCU) for more than 2 days were not visited by the dedicated anesthesiologists and were excluded from the analysis because follow-up in these patients was conducted by intensivists or cardiologists as part of our local protocol
Summary
An increased serum cardiac troponin level, as a marker for postoperative myocardial injury, has been shown to be an independent predictor of morbidity and mortality within the first year after non-cardiac surgery (Devereaux et al 2017; Levy et al 2011; van Waes et al 2016; van Waes et al 2013). In October 2016, we implemented routine postoperative consultations by a dedicated anesthesia team in patients detected with an elevated troponin in the surveillance program. The goal of these visits was to improve postoperative follow-up and to potentially detect or prevent complications at an early stage. This study aimed to evaluate the effect of these visits by dedicated anesthesiologists on early detection of complications and postoperative care utility in patients with troponin elevation after noncardiac surgery. We implemented a dedicated anesthesia team to conduct follow-up on patients with postoperative troponin elevation We hypothesized that these visits would facilitate early detection of complications. The aim of this study was to evaluate the effect of postoperative visits by dedicated anesthesiologists on early detection of complications and care utility
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