Abstract 11776: The Questionable Clinical Impact of Routine Pre-operative Cardiology Consultation Prior to Vascular Surgical Procedures

Abstract

Objective: No significant evidence basis exists for who and when a preoperative cardiac consultation should be obtained. We sought to define the variation in preoperative cardiology for patients requiring a vascular surgical procedure and determine whether this was associated with differences in perioperative myocardial infarction (poMI) or death. Methods: A 29 hospital statewide QI collaborative were queried for open aortic aneurysm repair, EVAR, and open vascular bypass procedures. Preprocedure documented cardiac consultation as well as stress testing was determined as part of the database. The primary outcome was poMI and death. Results: Among 5191 patients, 48% had a documented preoperative cardiac cardiology consultation, with the poMI rate of 2.1% and a 1.3% death rate. Across hospitals, preoperative cardiac consultation varied from <10% to over 85%, and was not dependent on the procedural volume, academic versus community status , or hospital size. Cardiology consultation rates correlated with stress test usage (Pearson ρ = 0.6; p < .001). Stratification of patients by the Revised Cardiac Risk Index (RCRI) categories showed consultation varied significantly by classification; RCRI=1; 38% had preoperative cardiology consult rate versus an RCRI =4; 66% had a cardiology consult. After stratification by RCRI, there was no association between cardiac consultation use and lower postoperative MI rate (Table) or death rate. Moreover, use of preoperative cardioprotective medications was not more common in those hospitals with high (> 50%) cardiology consultation rates as compared to lower consultation hospitals. Discussion: Preoperative cardiology consultation for vascular surgical patients varies greatly between institutions. Cardiology consultation was not associated with better utilization of cardioprotective medications nor was it associated with a lower incidence of death or myocardial infarction. MI Frequency by Cardiac Consultation