Cardiology Consultation in Noncardiac Surgery

Study Overview
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Brief Summary
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Recently, a predictive model has been developed to assess the risk of myocardial infarction or cardiac arrest (MICA) during and after surgery using the American Society of Surgeons' National Surgical Quality Improvement Program (NSQIP) database. In this MICA model, 180 hospital databases were used in 2007 and 2008 and included more than 200 000 patients. The Gupta score developed with this MICA model identified five predictors of perioperative myocardial infarction and cardiac arrest: type of surgery, functional status, creatinine increase (>130 mmol/L or >1.5 mg/dL), age, and American Association of Anesthesiologists (ASA) class. The Gupta score is presented as an interactive risk calculation program in the 2014 guideline of the ACC/AHA. The risk can be calculated simply and accurately at the bedside or clinic. The Gupta score is in spreadsheet format and can be downloaded online at http://www.surgicalriskcalculator.com/miorcardiacarrest. Unlike the previously used indexes, a scoring system has not been established. An estimate of the probability of myocardial infarction/cardiac arrest is provided for individual patients. In this study, the primary aim was to compare the frequency of cardiology consultation requests according to the use of the Gupta score. The secondary aim is to evaluate the perioperative clinical results (coronary angiography, ECHO, acute coronary syndrome, arrhythmia, 30-day mortality, etc.).SPSS 21.0 (Version 22.0, SPSS, Inc, Chicago, IL, USA) program will be used for statistical analysis. After applying the Shapiro-Wilk test for normality, the student's t-test will be used if the distribution is normal, and the Mann-Whitey U test will be used if the distribution is not normal. Fisher's exact test or chi-square test will be used for categorical variables. Results p<0.05 will be considered significant.

Detailed Description
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All patients undergoing non-cardiac surgery are at risk of major perioperative cardiovascular events. Cardiac complications account for 42% of the overall complications of these surgeries. Therefore, cardiologists are the most frequently consulted specialists in preoperative evaluation. Unnecessary cardiology consultations may cause comments that will not affect the practice of anesthesia, inappropriate tests and interventions, and delay in the surgical procedure. Recently, a predictive model has been developed to assess the risk of myocardial infarction or cardiac arrest (MICA) during and after surgery using the American Society of Surgeons' National Surgical Quality Improvement Program (NSQIP) database. In this MICA model, 180 hospital databases were used in 2007 and 2008 and included more than 200 000 patients. The Gupta score developed with this MICA model identified five predictors of perioperative myocardial infarction and cardiac arrest: type of surgery, functional status, creatinine increase (>130 mmol/L or >1.5 mg/dL), age, and American Association of Anesthesiologists (ASA) class. The Gupta score is presented as an interactive risk calculation program in the 2014 guideline of the ACC/AHA. The risk can be calculated simply and accurately at the bedside or clinic. The Gupta score is in spreadsheet format and can be downloaded online at http://www.surgicalriskcalculator.com/miorcardiacarrest. Unlike the previously used indexes, a scoring system has not been established. An estimate of the probability of myocardial infarction/cardiac arrest is provided for individual patients.

Official Title
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Impact of 2014 ACC/AHA Perioperative Guidelines on Cardiological Resource Use in Noncardiac Surgery Patients

Conditions
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Myocardial Infarction, Surgery-Complications

Intervention / Treatment
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* Other: Gupta score


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients undergoing non-cardiovascular surgery Patients evaluated routinely preoperatively in the anesthesiologist preoperative outpatient clinic Exclusion Criteria: Emergency surgeries ASA Physical Status V Patients undergoing cardiovascular surgery Minor surgeries Patients who did not want to participate in the study

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 99 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Gupta group<br>Cardiology consultation requested using Gupta score | Other: Gupta score<br>* The Gupta score is presented as an interactive risk calculation program in the 2014 guideline of the ACC/AHA. The Gupta score developed with this MICA model identified five predictors of perioperative myocardial infarction and cardiac arrest: type of surgery, functional status, creatinine increase (>130 mmol/L or >1.5 mg/dL), age, and American Association of Anesthesiologists (ASA) class. The frequency of cardiology consultation requests will be investigated according to the use of the Gupta score.<br>|
| Non-Gupta group<br>Number of cardiology consultations requested without using Gupta score | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Gupta score | The frequency of cardiology consultation requests will be compared according to the use of the Gupta score. | perioperative period | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Perioperative clinical results | Perioperative clinical results (coronary angiography, ECHO, acute coronary syndrome, arrhythmia, 30-day mortality, etc.) will be evaluated. | perioperative period | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Cardiology consultation, ACC/AHA guidelines, Perioperative cardiac risk