Charles de Mestral, Husam M Abdel-Qadir, Peter C Austin, Alice S Chong, Finlay A McAlister, Thomas F Lindsay, Heather J Ross, George Oreopoulos, Duminda N Wijeysundera, Douglas S Lee
{"title":"在预定的大血管手术前进行非住院心脏内科或普通内科评估有助于改善手术效果。","authors":"Charles de Mestral, Husam M Abdel-Qadir, Peter C Austin, Alice S Chong, Finlay A McAlister, Thomas F Lindsay, Heather J Ross, George Oreopoulos, Duminda N Wijeysundera, Douglas S Lee","doi":"10.1097/SLA.0000000000006321","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>To characterize the association between ambulatory cardiology or general internal medicine (GIM) assessment before surgery and outcomes after scheduled major vascular surgery.</p><p><strong>Background: </strong>Cardiovascular risk assessment and management before high-risk surgery remains an evolving area of care.</p><p><strong>Methods: </strong>This is a population-based retrospective cohort study of all adults who underwent scheduled major vascular surgery in Ontario, Canada, from April 1, 2004 to March 31, 2019. Patients who had an ambulatory cardiology and/or GIM assessment within 6 months before surgery were compared with those who did not. The primary outcome was 30-day mortality. Secondary outcomes included: composite of 30-day mortality, myocardial infarction or stroke, 30-day cardiovascular death, 1-year mortality, composite of 1-year mortality, myocardial infarction or stroke, and 1-year cardiovascular death. Cox proportional hazard regression using inverse probability of treatment weighting was used to mitigate confounding by indication.</p><p><strong>Results: </strong>Among 50,228 patients, 20,484 (40.8%) underwent an ambulatory assessment before surgery: 11,074 (54.1%) with cardiology, 8071 (39.4%) with GIM, and 1339 (6.5%) with both. Compared with patients who did not, those who underwent an assessment had a higher Revised Cardiac Risk Index [N with Index over 2 = 4989 (24.4%) vs 4587 (15.4%), P < 0.001] and more frequent preoperative cardiac testing [N = 7772 (37.9%) vs 6113 (20.6%), P < 0.001], but lower 30-day mortality [N = 551 (2.7%) vs 970 (3.3%), P < 0.001]. After the application of inverse probability of treatment weighting, cardiology or GIM assessment before surgery remained associated with a lower 30-day mortality [weighted hazard ratio (95% CI) = 0.73 (0.65-0.82)] and a lower rate of all secondary outcomes.</p><p><strong>Conclusions: </strong>Major vascular surgery patients assessed by a cardiology or GIM physician before surgery have better outcomes than those who are not. Further research is needed to better understand potential mechanisms of benefit.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"339-345"},"PeriodicalIF":7.5000,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Ambulatory Cardiology or General Internal Medicine Assessment Before Scheduled Major Vascular Surgery Is Associated with Improved Outcomes.\",\"authors\":\"Charles de Mestral, Husam M Abdel-Qadir, Peter C Austin, Alice S Chong, Finlay A McAlister, Thomas F Lindsay, Heather J Ross, George Oreopoulos, Duminda N Wijeysundera, Douglas S Lee\",\"doi\":\"10.1097/SLA.0000000000006321\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>To characterize the association between ambulatory cardiology or general internal medicine (GIM) assessment before surgery and outcomes after scheduled major vascular surgery.</p><p><strong>Background: </strong>Cardiovascular risk assessment and management before high-risk surgery remains an evolving area of care.</p><p><strong>Methods: </strong>This is a population-based retrospective cohort study of all adults who underwent scheduled major vascular surgery in Ontario, Canada, from April 1, 2004 to March 31, 2019. Patients who had an ambulatory cardiology and/or GIM assessment within 6 months before surgery were compared with those who did not. The primary outcome was 30-day mortality. Secondary outcomes included: composite of 30-day mortality, myocardial infarction or stroke, 30-day cardiovascular death, 1-year mortality, composite of 1-year mortality, myocardial infarction or stroke, and 1-year cardiovascular death. Cox proportional hazard regression using inverse probability of treatment weighting was used to mitigate confounding by indication.</p><p><strong>Results: </strong>Among 50,228 patients, 20,484 (40.8%) underwent an ambulatory assessment before surgery: 11,074 (54.1%) with cardiology, 8071 (39.4%) with GIM, and 1339 (6.5%) with both. Compared with patients who did not, those who underwent an assessment had a higher Revised Cardiac Risk Index [N with Index over 2 = 4989 (24.4%) vs 4587 (15.4%), P < 0.001] and more frequent preoperative cardiac testing [N = 7772 (37.9%) vs 6113 (20.6%), P < 0.001], but lower 30-day mortality [N = 551 (2.7%) vs 970 (3.3%), P < 0.001]. After the application of inverse probability of treatment weighting, cardiology or GIM assessment before surgery remained associated with a lower 30-day mortality [weighted hazard ratio (95% CI) = 0.73 (0.65-0.82)] and a lower rate of all secondary outcomes.</p><p><strong>Conclusions: </strong>Major vascular surgery patients assessed by a cardiology or GIM physician before surgery have better outcomes than those who are not. Further research is needed to better understand potential mechanisms of benefit.</p>\",\"PeriodicalId\":8017,\"journal\":{\"name\":\"Annals of surgery\",\"volume\":\" \",\"pages\":\"339-345\"},\"PeriodicalIF\":7.5000,\"publicationDate\":\"2025-08-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Annals of surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/SLA.0000000000006321\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/5/6 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"SURGERY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/SLA.0000000000006321","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/5/6 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"SURGERY","Score":null,"Total":0}
Ambulatory Cardiology or General Internal Medicine Assessment Before Scheduled Major Vascular Surgery Is Associated with Improved Outcomes.
Objective: To characterize the association between ambulatory cardiology or general internal medicine (GIM) assessment before surgery and outcomes after scheduled major vascular surgery.
Background: Cardiovascular risk assessment and management before high-risk surgery remains an evolving area of care.
Methods: This is a population-based retrospective cohort study of all adults who underwent scheduled major vascular surgery in Ontario, Canada, from April 1, 2004 to March 31, 2019. Patients who had an ambulatory cardiology and/or GIM assessment within 6 months before surgery were compared with those who did not. The primary outcome was 30-day mortality. Secondary outcomes included: composite of 30-day mortality, myocardial infarction or stroke, 30-day cardiovascular death, 1-year mortality, composite of 1-year mortality, myocardial infarction or stroke, and 1-year cardiovascular death. Cox proportional hazard regression using inverse probability of treatment weighting was used to mitigate confounding by indication.
Results: Among 50,228 patients, 20,484 (40.8%) underwent an ambulatory assessment before surgery: 11,074 (54.1%) with cardiology, 8071 (39.4%) with GIM, and 1339 (6.5%) with both. Compared with patients who did not, those who underwent an assessment had a higher Revised Cardiac Risk Index [N with Index over 2 = 4989 (24.4%) vs 4587 (15.4%), P < 0.001] and more frequent preoperative cardiac testing [N = 7772 (37.9%) vs 6113 (20.6%), P < 0.001], but lower 30-day mortality [N = 551 (2.7%) vs 970 (3.3%), P < 0.001]. After the application of inverse probability of treatment weighting, cardiology or GIM assessment before surgery remained associated with a lower 30-day mortality [weighted hazard ratio (95% CI) = 0.73 (0.65-0.82)] and a lower rate of all secondary outcomes.
Conclusions: Major vascular surgery patients assessed by a cardiology or GIM physician before surgery have better outcomes than those who are not. Further research is needed to better understand potential mechanisms of benefit.
期刊介绍：
The Annals of Surgery is a renowned surgery journal, recognized globally for its extensive scholarly references. It serves as a valuable resource for the international medical community by disseminating knowledge regarding important developments in surgical science and practice. Surgeons regularly turn to the Annals of Surgery to stay updated on innovative practices and techniques. The journal also offers special editorial features such as "Advances in Surgical Technique," offering timely coverage of ongoing clinical issues. Additionally, the journal publishes monthly review articles that address the latest concerns in surgical practice.
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