Research

A prospective observational study of preoperative natriuretic peptide testing in adult non-cardiac surgical patients in hospitals in Western Cape Province, South Africa

C S Alphonsus, M Jagga, M Crowther, E Coetzee, G Davies, Z Fullerton, H A van Zyl, A Reed, E Cloete, J Roos, F Roodt, R N Rodseth, B M Biccard

Abstract


Background. International guidelines recommend risk stratification to identify high-risk non-cardiac surgical patients. It is also recommended that all patients aged ≥45 years with significant cardiovascular disease should have preoperative natriuretic peptide (NP) testing. Abnormal preoperative B-type NPs have a strong association with postoperative cardiac complications. In South African hospitals, it is not known how many patients with significant cardiovascular disease scheduled for intermediate- to high-risk surgery will have raised NPs.

Objectives. To determine the prevalence of abnormal (raised) NPs in non-cardiac surgical patients with cardiac clinical risk factors. A secondary objective was to develop a model to identify surgical patients who may benefit from preoperative NP screening.

Methods. The inclusion criteria were patients aged ≥45 years presenting for elective, non-obstetric, intermediate- to high-risk non-cardiac surgery with at least one of the following cardiovascular risk factors: a history of ischaemic heart disease or peripheral vascular disease (coronary equivalent); a history of stroke or transient ischaemic attack; a history of congestive cardiac failure; diabetes mellitus currently on an oral hypoglycaemic agent or insulin; and serum creatinine level >175 µmol/L (>2.0 mg/dL). Blood samples for N-terminal-prohormone B-type NP (NT-proBNP) were collected before induction of anaesthesia. The preoperative prognostic threshold for abnormal (raised) NT-proBNP was ≥300 pg/mL. A generalised linear mixed model was used to determine the association between the risk factors and an abnormal NT-proBNP level.

Results. Of 172 patients, 63 (37%) had an elevated preoperative NT-proBNP level. The comorbidities independently associated with elevated preoperative NT-proBNP were coronary artery disease or peripheral vascular disease, congestive cardiac failure, diabetes mellitus, and a creatinine level >175 µmol/L.

Conclusions. We strongly recommend that non-cardiac surgical patients aged ≥45 years undergoing intermediate- or high-risk non-cardiac surgery with a history of coronary artery disease/peripheral vascular disease, congestive cardiac failure, diabetes mellitus or elevated creatinine have preoperative NP testing as part of risk stratification.


Authors' affiliations

C S Alphonsus, Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, South Africa

M Jagga, Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, South Africa

M Crowther, Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, South Africa

E Coetzee, Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, South Africa

G Davies, Department of Anaesthesia, Paarl Provincial Hospital, Western Cape, South Africa

Z Fullerton, Department of Anaesthesia, Victoria Hospital, Cape Town, South Africa

H A van Zyl, Department of Anaesthesia, Worcester Hospital, Western Cape, South Africa

A Reed, Department of Anaesthesia, New Somerset Hospital, Cape Town, South Africa

E Cloete, Department of Anaesthesia, New Somerset Hospital, Cape Town, South Africa

J Roos, Department of Anaesthesia, Mitchells Plain Hospital, Cape Town, South Africa

F Roodt, Department of Anaesthesia, George Regional Hospital, Western Cape, South Africa

R N Rodseth, Discipline of Anaesthetics, University of KwaZulu-Natal, KwaZulu-Natal, South Africa

B M Biccard, Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, South Africa

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Keywords

Non-cardiac surgery; Preoperative risk stratification; Natriuretic peptide testing

Cite this article

South African Medical Journal 2021;111(4):338-342. DOI:10.7196/SAMJ.2021.v111i4.15226

Article History

Date submitted: 2021-03-31
Date published: 2021-03-31

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