Document Detail

Impact of perioperative cardiac assessment guidelines on management of orthopedic surgery patients.
MedLine Citation:
PMID:  17275461     Owner:  NLM     Status:  MEDLINE    
PURPOSE: The study assessed whether the American College of Cardiology/American Heart Association (ACC/AHA) preoperative cardiac assessment guidelines impact patient management and predict major cardiac events in patients undergoing orthopedic surgery. SUBJECTS AND METHODS: We conducted a retrospective review of 338 consecutive orthopedic preoperative evaluations performed by internal medicine consultants. Major cardiac events were defined as myocardial infarction, congestive heart failure, and sudden cardiac death. RESULTS: Major cardiac events occurred in 5.7% of patients. Patients with minor or absent ACC/AHA clinical risk predictors were less likely to have major cardiac events (P = .007). More than half (51%) of patients meeting ACC/AHA indications for noninvasive cardiac tests did not receive them. However, most (69%) major cardiac events occurred in patients not meeting criteria for cardiac testing. Abnormal noninvasive cardiac testing results did not alter medication recommendations and only resulted in coronary revascularization in 0.6% of patients. Only 3% of patients with abnormal noninvasive cardiac testing results had major cardiac events. Patients with abnormal cardiac test results were more likely to have recommendations for perioperative beta-blockade (P <.01). Patients aged more than 70 years (odds ratio 5.0; 95% confidence interval, 1.32-19.28) and patients undergoing hip surgery (odds ratio 7.5, 95% confidence interval, 1.02-54.55) were more likely to have major cardiac events. Major cardiac events occurred in 12% of urgent and 4% of elective procedures (P = .009). CONCLUSIONS: The ACC/AHA guidelines accurately predict cardiac risk in orthopedic surgery. Abnormal noninvasive cardiac test results rarely affected preoperative recommendations, but improved compliance with beta-blocker therapy. Advanced age, urgent procedures, and hip surgery were associated with increased risk of major cardiac events.
Stephen M Salerno; Daniel W Carlson; Eugene K Soh; Christopher J Lettieri
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The American journal of medicine     Volume:  120     ISSN:  1555-7162     ISO Abbreviation:  Am. J. Med.     Publication Date:  2007 Feb 
Date Detail:
Created Date:  2007-02-05     Completed Date:  2007-02-23     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0267200     Medline TA:  Am J Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  185.e1-6     Citation Subset:  AIM; IM    
Tripler Army Medical Center, Honolulu, HI 96859, USA.
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MeSH Terms
Adrenergic beta-Antagonists
Heart Diseases / etiology*
Heart Function Tests / utilization
Middle Aged
Orthopedic Procedures / adverse effects*
Practice Guidelines as Topic
Retrospective Studies
Risk Factors
Reg. No./Substance:
0/Adrenergic beta-Antagonists
Comment In:
Am J Med. 2007 Nov;120(11):e27; author reply e29   [PMID:  17976403 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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