Preoperative Cardiac Stress Testing in the Southern California Vascular Outcomes Improvement Collaborative

Abstract

The incidence of PCST varies widely across registries and institutions in the So Cal VOICe. Despite the wide variation, the incidence of new postoperative MI is exceptionally low. Further studies should evaluate the cost-effectiveness of the PCST practices and future quality improvement efforts should focus on standardization of indications for PCST.

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

“…Two studies were focused on Veterans 42,49 . Only a minority of studies had specific cardiac exclusion criteria 24,30,34,38,40,43,49 . Most of the included studies were observational using either cross‐sectional 22,24–26,28,34,40,41,45,46,48 or retrospective cohort designs (Table 1).…”

“…Fourteen of the 28 studies had a moderate risk of bias 22,24,25,27–29,31–34,36,41,43,49 . Nine had a low risk of bias, 30,38–40,42,44–47 and five had a high risk of bias (Table 1; Supporting Information: Tables ) 23,26,35,37,48 …”

“…42,49 Only a minority of studies had specific cardiac exclusion criteria. 24,30,34,38,40,43,49 Most of the included studies were observational using either cross-sectional 22,[24][25][26]28,34,40,41,45,46,48 or retrospective cohort designs (Table 1). 27,30,32,33,37,38,[42][43][44]47,49 Of those with an intervention, 23,29,31,35,36,39 none was a randomized controlled trials although one was a nonrandomized controlled trial (Supporting Information: Table 8).…”

Cardiac stress testing prior to abdominal aortic surgery: Widely variable utilization, costly, and of unclear benefit

“…As such, multiple manuscripts have demonstrated variation in cardiology consultation and cardiac stress testing prior to major vascular surgery. [4][5][6] In this issue of Vascular Medicine, Ponukumati and colleagues investigated the variation of cardiac stress testing prior to elective abdominal aortic aneurysm (AAA) surgery as well as the financial implications and the impact of stress testing on major adverse cardiovascular events postoperatively. 7 Analyzing 32,459 patients across 283 Vascular Quality Initiative (VQI) centers, the authors report that utilization of cardiac stress testing prior to elective endovascular aortic aneurysm repair (EVAR) and open AAA repair varied substantially.…”

“…As such, multiple manuscripts have demonstrated variation in cardiology consultation and cardiac stress testing prior to major vascular surgery. 4–6…”