Background: We performed a prospective, clinical audit in University Hospital Limerick between 20/2/2024 and 18/4/2024. Preoperative risk assessment is a cornerstone of risk reduction strategies. Cardiac testing is able to identify patients with high risk to develop major adverse cardiac events after surgical procedures.
Methods: We studied elective adult surgical patients staying in the hospital for over 24 hours. We collected preoperative data on demographics, planned procedures, cardiovascular risk factors, and biomarkers. We reviewed previous cardiac test reports including electrocardiogram (ECG), echocardiography (TTE), angiography, and stress testing. Exercise tolerance was documented. We assessed compliance with European Society of Cardiology (ESC) (2022) and British Society of Echocardiography (BSE) (2016) guidelines for ECG and TTE. Our target was over 50 patients with 80% power and a 0.05 alpha error.
Results: We assessed 45 eligible patients (53.3% male, mean age 64.7±15.3 years). The majority underwent vascular, general surgical, or gynaecological procedures: 14 (31.1%), 9 (20.0%), 8 (17.8%), respectively. ECG compliance was 97.8%, while overall TTE compliance was 73.3%. Three cases lacked recommended TTE reports at surgery (as per BSE, and ESC guidelines), and 11 patients had echocardiograms without guideline support. Disregarding TTEs older than 6 months, unsupported requests were 5, resulting in an overall compliance of 82.2%. Median TTE to surgery time was 140 days [interquartile range (IQR) 24–581 days], consistent for both symptomatic and recently symptomatic patients, at 114 days (IQR 18.5–485 days), and for asymptomatic patients at 145.5 days (IQR 35–581 days) (P=0.705). Two patients had TTEs on the surgery day.
Conclusions: Due to hospital capacity challenges, fewer patients were included than planned. ECG compliance was excellent. Few missed TTEs were related to prolonged accepted time between TTE and surgery. TTEs without guideline support highlight the need for thorough assessment and biomarker screening to ease cardiology department burden. Requesting TTE on the surgery day may need review. This audit report can prompt anaesthesia department teaching events for developing a new local guideline.
