126 Should contemporary pre-operative assessment of non-cardiac surgery be more collaborative? A single centre cardiology-anaesthetic multidisciplinary experience. (17th July 2020)

• Record Type: Journal Article
• Authors: Palepu, Raja; McMaster, Chloe; Rogers, Lucy; Duffen, Adam; Dowse, Claire; Wilson, Hannah; De Silva, Kalpa
• Is Part Of: Heart. Volume 106(2020)Supplement 2
• Page Start: A104
• Page End: A105
• Publication Date: 2020-07-17
• Subjects: Pre-operative cardiology -- Anaesthesia -- Preventative medicine; Heart -- Diseases -- Treatment -- Periodicals; Cardiology -- Periodicals; 616.12
• DOI: 10.1136/heartjnl-2020-BCS.126
• Languages: English
• ISSNs: 1355-6037

Abstract

Abstract : Introduction: Perioperative management of patients undergoing non-cardiac surgery (NCS) is complex and challenging. Whilst overall mortality is low, approximately 40% of post-operative deaths are due to myocardial infarction. Historic management of such patients has been driven by anaesthetic-led care with limited systematic cardiology input. We have developed a unique cardiology-anaesthetic multi-disciplinary (CA-MDT) forum to discuss how to optimally manage high-risk cardiovascular patients undergoing general anaesthesia for NCS. We present a qualitative description, and present the data, for one-year from this service. Method: Data from all patients identified as having a high-risk cardiovascular profile via the anaesthetic led pre-operative assessment clinic (POAC), and discussed at the weekly CA-MDT during a one-year period (2019) are presented. Data collected in a consecutive cohort of patients awaiting NCS, include the proportion of cases discussed, nature of the discussion (Figure 1 ), the MDT outcome, the number and type of referrals for non-invasive imaging, ischaemia testing and/or angiography, and all-cause mortality. Results: During the 2019 calendar year, n=2509 patients were screened in the POAC, with 7% (n=184) deemed high-risk requiring discussion at the CA-MDT. 67% (n=123) were deemed fit for surgery without further investigation. 12% (n=22) had non-invasive ischaemia testing prior to surgery, most commonly with exercise or dobutamine stress echocardiography and 7% (n=13) had invasive angiography +/-PCI prior to surgery (Figure 2 ). 3% (n=6) had percutaneous revascularization prior to NCS due to a high-grade angina and/or a large burden of ischaemia identified on stress imaging or invasive functional assessment with Fractional Flow Reserve (FFR). Of the revascularized group, 83% (n=5) had surgery, with one patient being subsequently deemed too high risk for operative management. There was no significant delay to the planned NCS with all undergoing this within the initially planned timeline. Mortality within the entire cohort was 3.8%, with no cardiovascular deaths observed. All deaths were due to disease progression from cancer. Conclusion: The development of our CA-MDT demonstrates that a systematic and collaborative approach between cardiology and anaesthetics in the management of high-risk patients undergoing NCS is both feasible and time efficient; with no delay in intended surgical treatment seen in our initial observations. Moreover, this unique MDT forum streamlines and improves risk assessment of these complex patients. Finally, the increased cohesion between specialties may provide a more personalised approach to patient care, with the concept of precision medicine at the cornerstone of this strategy. Conflict of Interest: None