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Usefulness of intra-operative monitoring by internists in tertiary care centers in Metro Manila.

Author

Luciene Lourdes C. Villacin ,
Antonio L. Dans,
Felix Eduardo R. Punzalan Jr,
Maria Lourdes E. Amarillo,
Amor Baybay ,
Leonila Eseque ,
Grace Anne A. Banson-Herbosa,
Diadema de Jesus ,
Nelia A. Laborte,
Dante D. Morales DD,
Willie T. Ong,
Noel L. Rosas ,
Beaver R. Tamesis,
Bernadette A. Tumanan ,
Josephine R. Valdez ,
Maria Vanessa C. Villarruz

Related Institution

Philippine General Hospital

Makati Medical Center

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Publication Information

Publication Type
Journal
Publication Sub Type
Journal Article, Original
Title
Philippine Journal of Cardiology
Frequency
Quarterly
Publication Date
July-September 1997
Volume
25
Issue
3
Page(s)
115-120

Abstract

In the 1970s, Goldman desribed a classification system for predicting cardiac risk factors among patients undergoing non-cardiac surgery. Using such scoring system, internists and cardiologists in the Philippines have practiced a policy of intra-operative monitoring by internists. Up to the present time, there are still no studies regarding this practice.


This prospective anaytical survey aimed to: 1) To determine the proportions of operation in Metro Manila that undergo intra-operative monitoring by internists; 2) To determine the indications for intra-operative monitoring; 3) To identify the predictors of intra-operative monitoring; 4) To determine the usefulness of intra-operative monitoring from the point of view of the anesthesiologist, internist, and surgeon, and 5) To determine the average costs of pre-operative clearance and intra-operative monitoring.


One thousand one hundred nineteen consecutive operations in 6 tertiary care centers including 5 private hospitals and 1 goverment hospital were analyzed for above objectives. For objectives 1,2,4 and 5, descriptive statistics were used to summarize the data. For objective 3, logistics regression were used to identify independent predictors of intra-operative monitoring.


Results showed the following: 1) Eight percent (8%) of operations in Metro Manila underwent intra-operative monitoring [95% C.I.: .03, .13] ranging from 18.5% in hospital #1 to 2.7% in hospital #6. 2) The physicians indications for intra-operative monitoring were hypertension, arrhythmias, age, and chronic obstructive pulmonary disease (33%, 14%, 6% and 5% of monitored patients, respectively). 3) The independent predictors of intra-operative monitoring were: a) Those were classified under Goldman class II (OR = 9.79; 95% CI 5.33, 18.37) or Goldman class III and IV [OR = 22.26; 95% CI 6.95, 71.32] b) admission as a paying patient [OR = 3.68; 95% CI 0.99, 6.81] and c) admission to hospital #1 [OR=2.6; 95% CI 1.20, 11.36], hospital #2 [ OR=3.67; 95% CI 1.29, 10.46], hospital #3 [ OR=2.89; 95% CI 1.00, 8.35], or hospital #5 [OR=4.23; 95% CI 1.50, 11.92]. 4) Of the 91 cases monitored, intra-operative monitoring were deemed absolutely necessary or fairly useful by 87% of surgeons, 70% of internists and 62% of anesthesiologists. 5) The average cost of pre-operative clearance was P2,650 and that of intra-operative monitoring was P4,700.00 for a 2-hour surgical procedure.


Intra-operative monitoring is common and there is significant difference between hospital variability. This procedure must be evaluated as to its effectiveness and cost-effectiveness. Thus, further studies and guidelines should be developed to prevent its inappropriate use.

References

1. Goldman, L . "Multifactoral index of cardiac risk in noncardiac surgical procedures" N Engl J Med 297, 845-850, 1977
2. Samar-Sy, O , Bautista, A H , Leachon, A , Dans, A L , Tamesis, B , Sy, R . "Pre-operative predictors of complications among Filipinos undergoing non cardiac surgery in a tertiary general hospital. Presented at the Philippine Heart Association Annual Convention" , 1993
3. Goldman, L . "Cardiac risk and complications of noncardiac surgical procedures" Ann Intern Med 98, 504-513, 1983
4. Weitz, H H . "Noncardiac surgery in the patient with heart disease" Med Clinics North America 71, 413-428, 1987
5. Gerson, M . "Cardiac prognosis in noncardiac geriatric surgery" Ann Intern Med 103, 832-834, 1985

Physical Location

LocationLocation CodeAvailable FormatAvailability
Philippine Council for Health Research and Development Box No. 44 Fulltext Print Format
Philippine Council for Health Research and Development Fulltext pdf (Request Document)

 
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