PDF(Pubmed)
Abstract：
Patients with peripheral arterial disease have an increased risk of developing cardiovascular complications in the postoperative period of arterial surgeries known as Major Adverse Cardiac Events (MACE), which includes acute myocardial infarction, heart failure, malignant arrhythmias, and stroke. The preoperative evaluation aims to reduce mortality and the risk of MACE. However, there is no standardized approach to performing them. The aim of this study was to compare the preoperative evaluation conducted by general practitioners with those performed by cardiologists.
This is a retrospective analysis of medical records of patients who underwent elective arterial surgeries from January 2016 to December 2020 at a tertiary hospital in São Paulo, Brazil. The authors compared the preoperative evaluation of these patients according to the initial evaluator (general practitioners vs. cardiologists), assessing patients\' clinical factors, mortality, postoperative MACE incidence, rate of requested non-invasive stratification tests, length of hospital stay, among others.
281 patients were evaluated: 169 assessed by cardiologists and 112 by general practitioners. Cardiologists requested more non-invasive stratification tests (40.8%) compared to general practitioners (9%) (p < 0.001), with no impact on mortality (8.8% versus 10.7%; p = 0.609) and postoperative MACE incidence (10.6% versus 6.2%; p = 0.209). The total length of hospital stay was longer in the cardiologist group (17.27 versus 11.79 days; p < 0.001).
The increased request for exams didn\'t have a significant impact on mortality and postoperative MACE incidence, but prolonged the total length of hospital stay. Health managers should consider these findings and ensure appropriate utilization of human and financial resources.
This is a retrospective analysis of medical records of patients who underwent elective arterial surgeries from January 2016 to December 2020 at a tertiary hospital in São Paulo, Brazil. The authors compared the preoperative evaluation of these patients according to the initial evaluator (general practitioners vs. cardiologists), assessing patients\' clinical factors, mortality, postoperative MACE incidence, rate of requested non-invasive stratification tests, length of hospital stay, among others.
281 patients were evaluated: 169 assessed by cardiologists and 112 by general practitioners. Cardiologists requested more non-invasive stratification tests (40.8%) compared to general practitioners (9%) (p < 0.001), with no impact on mortality (8.8% versus 10.7%; p = 0.609) and postoperative MACE incidence (10.6% versus 6.2%; p = 0.209). The total length of hospital stay was longer in the cardiologist group (17.27 versus 11.79 days; p < 0.001).
The increased request for exams didn\'t have a significant impact on mortality and postoperative MACE incidence, but prolonged the total length of hospital stay. Health managers should consider these findings and ensure appropriate utilization of human and financial resources.
摘要：
背景：患有外周动脉疾病的患者在动脉手术后发生心血管并发症的风险增加，称为主要不良心脏事件（MACE），包括急性心肌梗塞,心力衰竭,恶性心律失常,和中风。术前评估旨在降低死亡率和MACE的风险。然而,没有标准化的方法来执行它们。这项研究的目的是比较全科医生与心脏病专家进行的术前评估。
方法：这是对2016年1月至2020年12月在圣保罗一家三级医院接受选择性动脉手术的患者病历的回顾性分析，巴西。作者根据初始评估者（全科医生与心脏病学家)，评估患者的临床因素，死亡率,术后MACE发生率,要求的非侵入性分层测试率，住院时间,在其他人中。
结果：对281例患者进行了评估：169例由心脏病专家评估，112例由全科医生评估。与全科医生（9％）相比，心脏病专家要求进行更多的非侵入性分层测试（40.8％）（p<0.001）。对死亡率(8.8%对10.7%;p=0.609)和术后MACE发生率(10.6%对6.2%;p=0.209)无影响。心脏病专家组的总住院时间更长（17.27天对11.79天；p<0.001）。
结论：增加的检查要求对死亡率和术后MACE发生率没有显著影响，但延长了住院时间。卫生管理人员应考虑这些发现，并确保适当利用人力和财政资源。
方法：这是对2016年1月至2020年12月在圣保罗一家三级医院接受选择性动脉手术的患者病历的回顾性分析，巴西。作者根据初始评估者（全科医生与心脏病学家)，评估患者的临床因素，死亡率,术后MACE发生率,要求的非侵入性分层测试率，住院时间,在其他人中。
结果：对281例患者进行了评估：169例由心脏病专家评估，112例由全科医生评估。与全科医生（9％）相比，心脏病专家要求进行更多的非侵入性分层测试（40.8％）（p<0.001）。对死亡率(8.8%对10.7%;p=0.609)和术后MACE发生率(10.6%对6.2%;p=0.209)无影响。心脏病专家组的总住院时间更长（17.27天对11.79天；p<0.001）。
结论：增加的检查要求对死亡率和术后MACE发生率没有显著影响，但延长了住院时间。卫生管理人员应考虑这些发现，并确保适当利用人力和财政资源。
