Evidence map›Paper›PMID 34031808›Full record

ArticleCanadian journal of anaesthesia = Journal canadien d'anesthesie2021

Implementation of the Canadian Cardiovascular Society guidelines for perioperative risk assessment and management: an interrupted time series study.

Daniel I McIsaac, Joshua Montroy, Sylvain Gagne, Chris Johnson, Jacelyn Ernst, Samantha Halman, Jeffrey Oake, James Chan, Susan Madden, Simon Feng and 6 more

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In one paragraph

Article in Canadian journal of anaesthesia = Journal canadien d'anesthesie, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
  2. Article
  3. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

16 authors.

Daniel I McIsaacDepartment of Anesthesiology and Pain Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada.
Joshua MontroyClinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
Sylvain GagneDepartment of Anesthesiology and Pain Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada.
Chris JohnsonDivision of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada.
Jacelyn ErnstDivision of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada.
Samantha HalmanDepartment of Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada.
Jeffrey OakeDepartment of Surgery, Division of Urology, University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada.
James ChanDepartment of Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada.
Susan MaddenDepartment of Anesthesiology and Pain Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada.
Simon FengDepartment of Anesthesiology and Pain Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada.
Michelle MoodyDepartment of Anesthesiology and Pain Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada.
Cedric Godbout SimardDepartment of Anesthesiology and Pain Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada.
Monica TaljaardClinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
Madison FosterClinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
Dean A FergussonClinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
Manoj M LaluDepartment of Anesthesiology and Pain Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada. mlalu@toh.ca.ORCID http://orcid.org/0000-0002-0322-382X

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeThe Canadian Cardiovascular Society (CCS) guidelines for patients undergoing non-cardiac surgery address the lack of standardized management for patients at risk of perioperative cardiovascular complications. Our interdisciplinary group evaluated the implementation of these guidelines.

methodsWe used an interrupted time series design to evaluate the effect of implementation of the CCS guidelines, using routinely collected hospital data. The study population consisted of elective, non-cardiac surgery patients who were: i) inpatients following surgery and ii) age ≥ 65 or age 45-64 yr with a Revised Cardiac Risk Index ≥ 1. Outcomes included adherence to troponin I (TnI) monitoring (primary) and adherence to appropriate consultant care for patients with elevated TnI (secondary). Exploratory outcomes included cost measures and clinical outcomes such as length of stay.

resultsWe included 1,421 patients (706 pre- and 715 post-implementation). We observed a 67% absolute increase (95% confidence interval, 55 to 80; P < 0.001) in adherence to TnI testing following the implementation of the guidelines. In patients who had elevated TnI following guideline implementation (n = 64), the majority (85%) received appropriate follow-up care in the form of a general medicine or cardiology consult, all received at least one electrocardiogram, and half received at least one advanced cardiac test (e.g., cardiac perfusion scan, or percutaneous intervention).

conclusionsOur study showed the ability to implement and adhere to the CCS guidelines. Large-scale multicentre evaluations of CCS guideline implementation are needed to gain a better understanding of potential effects on clinically relevant outcomes.

Indexed as

ElectrocardiographyCanadaHumansInterrupted Time Series AnalysisMiddle AgedRisk Assessmentguideline implementationinterrupted time seriesmyocardial injury after non-cardiac surgeryperioperative myocardial infarctionquality improvement

Identifiers

PMID34031808

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.