Physicians' recommendations for patients who undergo noncardiac surgery

Devereaux, P.J.; Ghali, William A.; Gibson, Neil E.; Skjodt, Neil M.; Ford, David C.; Quan, Hude; Guyatt, Gordon H.
April 2000
Clinical & Investigative Medicine;Apr2000, Vol. 23 Issue 2, p116
Academic Journal
Abstract Objective: To investigate how consulting physicians attempt to modify perioperative cardiac risk for patients who undergo noncardiac surgery by comparing the preoperative cardiac recommendations of consulting physicians in 2 university centres. Design: Retrospective cross-sectional analysis. Setting: Five hospitals affiliated with 2 Canadian universities. Patients: Three hundred and eight preoperative consultations were evaluated in 297 patients who were 40 years of age or older and scheduled for noncardiac surgery. Outcome measures: Cardiac drug recommendations at the preoperative and perioperative consultations; overall recommendations and practice variation between the 2 centres. Results: The greatest changes in drug management suggested by consultants were the initiation of nitrates in 13% of the patients and a decrease in acetylsalicylic acid administration from 27% to 17%. Centre A physicians recommended adding an angiotensin-converting enzyme inhibitor 11% of the time, whereas centre B physicians recommended such an inhibitor in only 1% of the patients (p = 0.001). In patients taking acetylsalicylic acid at the preoperative consultation, Centres A and B physicians recommended withholding the drug 47% and 22% of the time, respectively (p = 0.03). These differences persisted between the 2 centres after controlling for physician estimates of risk. Conclusions: Consultants frequently recommended perioperative changes in the use of cardiac medications, and there were differences in practice patterns between the 2 centres. These differences may be affecting patient outcomes and highlight the need for randomized clinical trials to determine the impact of perioperative drug administration on bleeding, myocardial infarction and death.


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