Frequency of Appropriate and Low-Risk Noncardiac Preoperative Stress Testing Across Medical Specialties

Peterson, Brandon; Ghahramani, Mehrdad; Emerich, Matthew; Foy, Andrew

doi:10.1016/j.amjcard.2018.05.007

Cited by 9 publications

(11 citation statements)

References 9 publications

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“…The fact that preoperative invasive procedures such as coronary artery bypass grafting or percutaneous coronary angioplasty do not reduce perioperative risk in patients with significant stable CAD is highlighted (7,10). These findings also reinforce that the request for these preoperative exams results in over-diagnosis with subsequent unnecessary treatments, without a solid evidence base that the outcome is positive considering benefits, costs, and possible damages (11,14,29).…”

Section: Discussionmentioning

confidence: 96%

Inappropriate screening of obstructive coronary artery disease during pre-anesthesia assessment of candidates for non-cardiac surgery

Oliveira

Santos

Silva

et al. 2021

Braz J Med Biol Res

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Preoperative evaluation in elective surgeries has been associated with successful surgical treatment. However, there is no solid scientific evidence that screening for coronary artery disease (CAD) reduces surgical risk. The aims of this study were to describe the frequency of inappropriate investigation of obstructive CAD induced by pre-anesthetic assessment in individuals without cardiovascular symptoms (candidates for low-to intermediate-risk surgeries) and to evaluate predictors of this conduct. We performed a retrospective evaluation of medical records of anesthesiology services from patients undergoing preanesthesia assessment between May 2015 and May 2016, including those with functional capacity X4 metabolic equivalents without a diagnosis of heart disease. A total of 778 medical records (47 ± 16 years of age, 62.6% female) were studied. A private hospital performed 50.1% of the surgeries and 60.4% were of intermediate risk. Only 2.7% (95%CI: 1.7-4.1%) were screened for CAD, and 91% of these requests were mediated by cardiology consultations performed during pre-anesthetic testing visits. Factors associated with screening for CAD were hypertension, diabetes, moderate systemic disease (ASA III), cardiac consultation, previous diagnosis of CAD, and admission to a private hospital. Independent predictors were private hospitals (OR: 3.9; 95%CI: 1.3-11.0), ASA III (OR: 5.3; 95%CI: 1.7-16.2), and hypertension (OR: 3.8; 95%CI: 1.5-9.8). The frequency of inappropriate requests for CAD screening in asymptomatic individuals without untreated systemic diseases was low in pre-anesthetic visits. Although infrequent, screening for CAD is more common in the private setting, in patients with poorer health status, and is usually prescribed during cardiology consultation.

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Section: Discussionmentioning

confidence: 96%

Inappropriate screening of obstructive coronary artery disease during pre-anesthesia assessment of candidates for non-cardiac surgery

Oliveira

Santos

Silva

et al. 2021

Braz J Med Biol Res

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“…Although the results observed are in compliance with the literature, they show a higher trend toward performing inappropriate cardiac stress tests when the cardiologist takes part in the preoperative process. 8 The result may also be partially associated with higher availability of diagnostic resources at the hospital analyzed, which belongs to a private hospital network, that normally has higher economic capacity. 20 , 21 , 22 , 23 , 24 …”

Section: Discussionmentioning

confidence: 99%

“…7 Thus, surgical patients generally undergo extensive preoperative evaluations with no solid evidence that diagnostic benefits outweigh costs and possible damage. 4 , 8 …”

Section: Introductionmentioning

confidence: 99%

“…Hence, several studies 5 , 6 , 8 , 9 and health guidelines 10 , 11 widely criticize the common practice of performing extensive and non-selective preoperative tests for asymptomatic patients with a controlled systemic condition and at least moderate functional capacity, and referring them to a medical consultation with a specialist before undergoing minor and intermediate risk non-cardiac surgeries. Additionally, more than 95% of patients submitted to elective minor and intermediate risk surgeries do not require coronary tests or complementary tests before undergoing the procedure in the scenario above.…”

Section: Introductionmentioning

confidence: 99%

“…Additionally, more than 95% of patients submitted to elective minor and intermediate risk surgeries do not require coronary tests or complementary tests before undergoing the procedure in the scenario above. 4 , 8 , 11…”

Section: Introductionmentioning

confidence: 99%

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The inductor role of cardiac consultation in the pre-anesthetic evaluation of asymptomatic patients submitted to non-cardiac minor and intermediate-risk surgery: a cross-sectional study

Oliveira

Schwingel

Santos

et al. 2021

Brazilian Journal of Anesthesiology (English Edition)

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Patient, provider, and system‐level factors associated with preoperative cardiac testing: A systematic review

Ellenbogen,

Drmanovic,

Segal

et al. 2023

Journal of Hospital Medicine

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BackgroundOveruse of preoperative cardiac testing contributes to high healthcare costs and delayed surgeries. A large body of research has evaluated factors associated with variation in preoperative cardiac testing. However, patient, provider, and system‐level factors associated with variation in testing have not been systematically studied.ObjectiveTo conduct a systematic review to better delineate the patient, provider, and system‐level factors associated with variation in preoperative cardiac testing.MethodsWe included studies of an adult US population evaluating a patient, provider, or system‐level factor associated with variation in preoperative cardiac testing for noncardiac surgery since 2012. Our search strategy used terms related to preoperative testing, diagnostic cardiac tests, and care variation with Ovid MEDLINE and Embase from inception through January 2023. We extracted study characteristics and factors associated with variation and qualitatively analyzed them. We assessed risk of bias using the Newcastle–Ottawa Scale and Evidence Project Risk of Bias tool.ResultsTwenty‐eight articles met inclusion criteria. Older age and higher comorbidity were strongly associated with higher‐intensity testing. The evidence for provider and system‐level covariates was weaker. However, there was strong evidence that a focus on primary care and away from preoperative clinic and cardiac consultations was associated with less testing and that interventions to reduce low‐value testing can be successful.ConclusionsThere is significant interprovider and interhospital variation in preoperative cardiac testing, the correlates of which are not well‐defined. Further work should aim to better understand these factors.

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Frequency of Appropriate and Low-Risk Noncardiac Preoperative Stress Testing Across Medical Specialties

Cited by 9 publications

References 9 publications

Inappropriate screening of obstructive coronary artery disease during pre-anesthesia assessment of candidates for non-cardiac surgery

Inappropriate screening of obstructive coronary artery disease during pre-anesthesia assessment of candidates for non-cardiac surgery

The inductor role of cardiac consultation in the pre-anesthetic evaluation of asymptomatic patients submitted to non-cardiac minor and intermediate-risk surgery: a cross-sectional study

Patient, provider, and system‐level factors associated with preoperative cardiac testing: A systematic review

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