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Canadian Journal of Anesthesia/Journal canadien d'anesthésie
Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie 8/2021

01-08-2021 | Heart Surgery | Reports of Original Investigations

Implementation of the Canadian Cardiovascular Society guidelines for perioperative risk assessment and management: an interrupted time series study

Authors: Daniel I. McIsaac, MD, MSc, Joshua Montroy, MSc, Sylvain Gagne, MD, Chris Johnson, MD, Jacelyn Ernst, MD, Samantha Halman, MD, Jeffrey Oake, MD, James Chan, MD, Susan Madden, BScN, Simon Feng, MD, Michelle Moody, MD, Cedric Godbout Simard, MD, Monica Taljaard, PhD, Madison Foster, MSc, Dean A. Fergusson, PhD, Manoj M. Lalu, PhD

Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Issue 8/2021

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Abstract

Purpose

The Canadian Cardiovascular Society (CCS) guidelines for patients undergoing non-cardiac surgery address the lack of standardized management for patients at risk of perioperative cardiovascular complications. Our interdisciplinary group evaluated the implementation of these guidelines.

Methods

We used an interrupted time series design to evaluate the effect of implementation of the CCS guidelines, using routinely collected hospital data. The study population consisted of elective, non-cardiac surgery patients who were: i) inpatients following surgery and ii) age ≥ 65 or age 45–64 yr with a Revised Cardiac Risk Index ≥ 1. Outcomes included adherence to troponin I (TnI) monitoring (primary) and adherence to appropriate consultant care for patients with elevated TnI (secondary). Exploratory outcomes included cost measures and clinical outcomes such as length of stay.

Results

We included 1,421 patients (706 pre- and 715 post-implementation). We observed a 67% absolute increase (95% confidence interval, 55 to 80; P < 0.001) in adherence to TnI testing following the implementation of the guidelines. In patients who had elevated TnI following guideline implementation (n = 64), the majority (85%) received appropriate follow-up care in the form of a general medicine or cardiology consult, all received at least one electrocardiogram, and half received at least one advanced cardiac test (e.g., cardiac perfusion scan, or percutaneous intervention).

Conclusions

Our study showed the ability to implement and adhere to the CCS guidelines. Large-scale multicentre evaluations of CCS guideline implementation are needed to gain a better understanding of potential effects on clinically relevant outcomes.
Appendix
Available only for authorised users
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Metadata
Title
Implementation of the Canadian Cardiovascular Society guidelines for perioperative risk assessment and management: an interrupted time series study
Authors
Daniel I. McIsaac, MD, MSc
Joshua Montroy, MSc
Sylvain Gagne, MD
Chris Johnson, MD
Jacelyn Ernst, MD
Samantha Halman, MD
Jeffrey Oake, MD
James Chan, MD
Susan Madden, BScN
Simon Feng, MD
Michelle Moody, MD
Cedric Godbout Simard, MD
Monica Taljaard, PhD
Madison Foster, MSc
Dean A. Fergusson, PhD
Manoj M. Lalu, PhD
Publication date
01-08-2021
Publisher
Springer International Publishing
Published in
Canadian Journal of Anesthesia/Journal canadien d'anesthésie / Issue 8/2021
Print ISSN: 0832-610X
Electronic ISSN: 1496-8975
DOI
https://doi.org/10.1007/s12630-021-02026-x

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