ArticleCanadian journal of anaesthesia = Journal canadien d'anesthesie2025
Cardiac risk assessment after noncardiac surgery: a historical cohort study on guideline adherence at a Canadian quaternary care centre.
Article in Canadian journal of anaesthesia = Journal canadien d'anesthesie, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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1 citing paper in PubMed.
- Seeking guidance in preoperative cardiac assessment guidelines.Canadian journal of anaesthesia = Journal canadien d'anesthesie · 2025Article
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5 authors.
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Abstract
purposeCardiac complications after noncardiac surgery remain a leading source of postoperative morbidity and mortality. In 2016, the Canadian Cardiovascular Society (CCS) published guidelines that outlined an approach to perioperative cardiac risk assessment for noncardiac surgery, integrating biomarkers. We sought to evaluate the adherence to these guidelines at McGill University Health Centre, a quaternary care hospital in Montreal, QC, Canada.
methodsWe conducted a historical cohort study of all patients undergoing elective noncardiac surgery requiring overnight stay between January 2018 and December 2019. The primary outcome was adherence to preoperative B-type natriuretic peptide (BNP) measurement. Secondary outcomes included adherence to postoperative troponin and electrocardiogram (ECG) acquisition, and 30-day postoperative outcomes.
resultsAmong our cohort of 3,623 patients, BNP measurement adherence was 52.4%. Troponin and ECG acquisition adherence was 34.6% and 30.5%, respectively. Patients with an elevated preoperative BNP had higher incidences of 30-day myocardial injury after noncardiac surgery (20.2% vs 4.3%; P < 0.001), myocardial infarction (5.2% vs 0.5%; P < 0.001), mortality (2.5% vs 0.6%; P < 0.001), and to a lesser extent, cardiac arrest and heart failure decompensation. Patients with elevated postoperative troponin levels had higher incidences of 30-day myocardial infarction (20.7% vs 0.0%; P < 0.001), mortality (7.8% vs 0.6%; P < 0.001), and to a lesser extent, cardiac arrest and heart failure decompensation. Elevated BNP and troponin levels were associated with higher physician follow-up rates.
conclusionsAbout half of the patients undergoing noncardiac surgery in our cohort underwent BNP screening as recommended by CCS guidelines; troponin and ECG acquisition adherence was even lower. While postoperative cardiac ischemia is associated with increased 30-day morbidity and mortality, more studies exploring physician risk stratification practice and the impact of increased testing on long-term outcomes are needed.
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