Project aims to improve perioperative cardiac risk evaluation and management for noncardiac surgeryNovember 30, 2018
Over 200 million adults undergo noncardiac surgical procedures worldwide every year. Of these, more than 8 million people will suffer a major cardiac complication. In 2016, the Canadian Cardiovascular Society introduced new guidelines on perioperative cardiac risk assessment and management for patients who undergo inpatient noncardiac surgery. With funding from the Vancouver Physician Staff Association (VPSA), a multidisciplinary team of VCH physicians has been working to develop standardized order sets and protocols and to educate surgical staff on the clinical practice changes needed to comply with guideline-driven perioperative care.
“The new Canadian guidelines represent a radical departure from previous European and American guidelines,” says cardiologist Dr. James McKinney who co-leads the project with Dr. Erin Sloan, General Internal Medicine. “There is a higher risk for myocardial injury in the post-operative period than was originally thought. The guidelines will help us identify high-risk patients and make sure they are followed after their noncardiac surgeries. Ten per cent of people die within 30 days if they have a postoperative elevation in troponin, and 93 per cent of those people have no ischemic symptoms.”
“The guidelines identified a simple blood test, BNP (Brain Natriuretic Peptide) or NT-proBNP, as an independent predictor of perioperative morbidity and mortality,” adds Dr. Sloan. “All patients 65 years and older, and all patients over age 45 with defined cardiovascular risk factors should undergo preoperative BNP screening prior to inpatient noncardiac surgery. Patients with an elevated preoperative BNP are at increased risk of perioperative myocardial infarction, cardiac arrest and cardiovascular related death within 30 days following noncardiac surgery and should be monitored with an ECG and routine postoperative troponin measurements.”
Working across a multitude of disciplines including anesthesia (Drs. Kevin Froehlich, Don Young, Beau Klaibert), internal medicine (Drs. Sloan, Iain Mackie, Zachary Schwartz, Terence Yung), laboratory medicine (Dr. Morris Pudek), and cardiology (Drs. McKinney, Ken Gin, Rudy Chow, Ken Kaila) in Vancouver Acute and Providence, the team has been meeting for over a year to bring all the players together and identify local practices.
“We have discussed and critiqued current evidence and developed orders and protocols to standardize processes,” says Dr. McKinney. “We have spoken to most of the surgical sub-specialties and are expanding to involve other areas of medicine and surgery.”
VPSA funding additional projects
VPSA members can apply for funding for projects for physician-led projects that will improve collaboration amongst facility-based physicians, across divisions and/or departments, or between facility- based and community physicians. The VPSA Engagement Accelerator provides funding between $5,000 and $20,000; deadline for applications is November 26. Small Steps, Big Ideas provides between $1,000 and $5,000 for smaller projects; applications are accepted on a rolling basis.
For more information on the Vancouver Physician Staff Association, visit its website.