title: Preoperative cardiac evaluation: when should the surgeon consult the cardiologist?
abstract: OBJECTIVE
  We compiled a manual aimed at reducing preoperative cardiac assessment costs and defining the roles of surgeons and cardiologists. We tested prospectively and retrospectively if this manual achieved these goals.
  
  
  METHODS
  Using the Guidelines for Perioperative Cardiovascular Evaluation for Noncardiac Surgery of the American College of Cardiology (ACC) / American Heart Association (AHA), and other articles as a reference, we compiled the Jichi Medical School Hospital (JMSH) Manual in September 2002. This manual contains a novel checklist and flowcharts and includes all past and present cardiac disorders, complications, abnormalities in electrocardiograms (ECGs) and chest X-rays, and evaluation of daily activity. Using this manual, we prospectively studied 1087 surgical candidates from September 2002 to August 2003, and retrospectively analyzed 927 surgical candidates from September 2001 to August 2002.
  
  
  RESULTS
  In the prospective study, 39 (3.6%) patients were deemed to require further cardiac assessment and 4 (0.37%) suffered postoperative complications. In the retrospective study, 108 (11.7%) were deemed to require further cardiac assessment and 20 (2.2%) suffered postoperative complications. Using this manual reduced preoperative cardiac examination costs by 1323,600 Japanese yen, representing a 70.5% reduction.
  
  
  CONCLUSIONS
  The JMSH Manual defines the roles of surgeons and cardiologists and is useful for assessing preoperative cardiac function and surgical risks. This manual dramatically reduced the costs associated with preoperative cardiac examinations.
authors.affiliation: Department of Surgery, Division of Cardiovascular Medicine, Jichi Medical School, 3311-1 Yakushiji, Minami-kawachi, Tochigi, 329-0498, Japan.
authors.forename: Masaru
authors.initials: M
authors.lastname: Koizumi
authors.forename: Naohiro
authors.initials: N
authors.lastname: Sata
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Yasuda
authors.forename: Hideo
authors.initials: H
authors.lastname: Nagai
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Saito
authors.forename: Yuji
authors.initials: Y
authors.lastname: Hayashi
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Shimada
mesh_terms: D002309:Cardiology; D002318:Cardiovascular Diseases / Q000175:diagnosis*; D006801:Humans; D008370:Manuals as Topic; D010819:Physician's Role; D011300:Preoperative Care / Q000592:standards*; D011446:Prospective Studies; D012017:Referral and Consultation; D012189:Retrospective Studies; D018570:Risk Assessment / Q000592:standards*; D013514:Surgical Procedures, Operative