The relationship between perioperative mortality/morbidity and preoperative evaluation of the patients with cardiovascular disease undergoing noncardiac surgery

The preoperative evaluation of patients undergoing noncardiac surgery with known or suspected cardiovascular disease is very important for the surgeon, anesthesiologist and cardiologist. Therefore many scoring and classification systems and algorithms about this topic have been published for making the evaluation easier and more objective. The aim of our study is to investigate the relationship between ASA classification, Goldman scoring system, cardiac risk determined by the cardiologist and the perioperative mortality and morbidity. After obtaining approval from Başkent University Clinical Research Committee, 500 patients undergoing noncardiac surgery with cardiovascular disease and consulted to a cardiologist for any reason by the surgeon or anesthesiologist aging older than 45 were studied prospectively between 06.01.08 and 15.10.08. The patients with massive bleeding and transfusion necessity, undergoing vascular or urgent surgery and needing vasopressor or hypotensive agents for the operation were excluded from the study. The relationship between the patients' ASA classes, Goldman scores, cardiac risks, comorbidities, operation types, preoperative cardiac symptoms and the perioperative morbidity-mortality was assessed. The patients were followed up intraoperatively and during postoperative 24 hours for the cardiovascular complications. The variables within the groups with or without morbidity were analysed with Student's T and Chi-square tests. The mean age in the group with morbidity (69.3 ± 10.6) was significantly higher than the group without morbidity (64.0 ± 12.1) (p<0.001) and the male/female ratio was similiar in both groups (p=0.200). There was no perioperative mortality in our study and of the 500 patients 354 (70.8%) had cardiovascular complications such as hypotension, hypertension, bradycardia, tachycardia, arrythmia, myocard infarction and cardiac arrest. While operation type of both groups were significantly different (p=0.001), preoperative hipertension was found higher in morbidity group (p=0.007). The anesthesia type and anesthetic agents which were used were similiar in both groups. The preoperative ASA classes (p=0.016), Goldman scores (p<0.001) and cardiac risks of patients (p=0.039) were significantly different between the groups with or without morbidity. As a multivariate test, logistic regression analysis was applied and only age, hypertension and operation type (abdominal surgery, orthopedic surgery, disc surgery and craniotomy) between the variables were found as a risk factor for perioperative morbidity. In conclusion, we think that ASA classification, Goldman Cardiac Risk Index and cardiac risk determined by cardiology consultation can affect the patients' perioperative management, monitoring and care. We also think that the usage of risk indices and algorithms can reduce the consultation requirement and unnecessary laboratory or imaging tests and can prevent the unnecessary cancellation or delaying of the surgery. Key words: Preoperative evaluation, noncardiac surgery, ASA classification, Goldman Cardiac Risk Index