The Internal Medicine Preoperative Assessment Consultation and Treatment (IMPACT) Center is a referral‐based clinic providing standardized preoperative evaluation by staff hospitalists. Our aim was to determine whether referral to the IMPACT Center decreased the likelihood of postoperative cardiac events in patients undergoing elective noncardiac surgery (NCS).
We performed a retrospective cohort study of 33,009 patients from January 2005 to December 2007 who underwent elective NCS requiring at least an overnight admission to the hospital. A nonpansimonious propensity model was developed to predict IMPACT Center referral. Patient demographics, laboratory values, comorbidities, type of surgery, surgical risk using a 5‐point scale based on procedural bleed risk, anesthesia risk using a 4‐point scale derived from a computerized questionnaire consisting of 148 interactive questions, prescribed medications, and prior surgical history were included in the model. Multiple logistic regression was used to determine significant predictors of postoperative cardiac events (troponin > 0.2). Beta‐blocker eligibility were defined using a standardized assessment and treatment protocol.
Overall, 61.6% of patients were assessed in the IMPACT Center. The propensity model for IMPACT referral demonstrated strong predictive ability (c statistic = 0.858). The odds ratio (OR) for IMPACT referral significantly reduced the risk of postoperative cardiac events (OR = 0.67, P < 0.05) even after rigorous adjustment for referral bias using propensity scone methods and controlling far patient age (OR = 1.04 per year, P < 0.001), hypertension (OR = 1.49, P = 0.044), heart failure (OR = 2.24. P = 0.001), peripheral vascular disease (OR = 2.46, P < 0.001), diabetes (OR = 1.57, P = 0.02), CAD (OR = 2.31, P < 0.001), renal disease (OR = 2.31, P < 0.001). DVT(OR = 2.31, P = 0.001). anesthesia risk (per unit on 4‐point scale; OR = 1.54, P < 0.001), BUN (per unit mg/dL; OR = 1.01, P = 0.022), creatinine (per unit mg/dL; OR = 1.1, P = 0.025), hemalocrit (per unit %; OR = 1.13, P = 0.008), and hemoglobin (per unit g/dL OR = 0.67, P = 0.005).
Preoperative patient assessment in a standardized setting like the IMPACT center was associated with reduced rales of postoperative cardiac events.
A. Rajamanickam, Cleveland Clinic, physician who evaluates patients in IMPACT, A. Usmani, Cleveland Clinic, physician who evaluated patients in IMPACT; E. Hixson, none; M. Pecic, none; A. Prabhakaran, Cleveland Clinic, physician who evaluates patients in IMPACT; A. Jaffer, Cleveland Clinic, physician who evaluated patients in IMPACT; B. Harte, Cleveland Clinic, physician who evaluates patients in IMPACT.
To cite this abstract:Rajamanickam A, Usmani A, Hixson E, Pecic M, Prabhakaran A, Jaffer A, Harte B. Postoperative Myocardial Infarction in Noncardiac Surgery Patients. Abstract published at Hospital Medicine 2010, April 8-11, Washington, D.C. Abstract 117. Journal of Hospital Medicine. 2010; 5 (suppl 1). https://www.shmabstracts.com/abstract/postoperative-myocardial-infarction-in-noncardiac-surgery-patients/. Accessed June 17, 2019.