Related Experiment Video
Updated: Jun 8, 2026
Noninvasive Determination of Vortex Formation Time Using Transesophageal Echocardiography During Cardiac Surgery
Published on: November 28, 2018
Anesthesiologists' preferences for preoperative cardiac evaluation before vascular surgery: results of a mail survey
John E Ellis1, Avery Tung, Helen Lee
1Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA. johnellis1700@gmail.com
Insights
Anesthesiologists generally follow cardiac guidelines for vascular surgery patients, but physician factors like gender and experience also influence decisions. Patient comorbidities and surgery type significantly impact requests for cardiac evaluations.
Area of Science:
- Cardiology
- Anesthesiology
- Health Services Research
Background:
- Preoperative cardiac evaluation is crucial for patients undergoing vascular surgery.
- Existing guidelines from the American College of Cardiology/American Heart Association (ACC/AHA) provide recommendations for cardiac risk assessment.
- Understanding factors influencing anesthesiologists' decisions is key to optimizing patient care.
Purpose of the Study:
- To determine if anesthesiologists' requests for preoperative cardiac evaluation before vascular surgery are influenced by patient comorbidity and surgical magnitude.
- To explore the impact of factors beyond ACC/AHA guidelines on these clinical decisions.
Main Methods:
- A survey was administered to 2,000 U.S. anesthesiologists.
- Respondents evaluated hypothetical vascular surgery patients with varying factors (comorbidities, functional status, surgery type, demographics).
- Multivariate ordinal logistic regression analyzed decision-making patterns for cardiology consultation, echocardiography, and stress testing.
Main Results:
- Increased patient comorbidities, poorer functional status, and greater surgical magnitude significantly increased recommendations for cardiology consultation, echocardiography, and stress testing.
- Anesthesiologists were more likely to recommend cardiology consultation with higher perceived perioperative myocardial infarction risk.
- Physician-specific factors, including female gender, less experience with the patient type, and geographic location (New England), influenced stress test recommendations.
Conclusions:
- Anesthesiologists' decisions for preoperative cardiac evaluation largely align with ACC/AHA guidelines.
- However, physician-related factors such as gender, years in practice, and familiarity with the procedure also play a role.
- These findings highlight the interplay between evidence-based guidelines and individual physician characteristics in clinical decision-making.
Study Objective:
To investigate whether anesthesiologists' decisions to request preoperative cardiac evaluation (cardiologist consultation, echocardiography, and cardiac stress testing) before vascular surgery were influenced by patient comorbidity and magnitude of surgery; and to explore whether factors unrelated to the American College of Cardiology/American Heart Association (ACC/AHA) guidelines influence these decisions.
Design:
Survey instrument.
Setting:
University medical center.
Subjects:
2,000 U.S. anesthesiologists who were mailed a survey.
Measurements:
Six factors in a hypothetical patient presenting for vascular surgery [gender, race (white vs. black), age (65 yrs vs. 85 yrs), comorbidities (sick vs. healthy), functional status, and magnitude of surgical stress] were evaluated. Respondents were asked about their demographics, practice patterns, and how they would manage the hypothetical patient.
Main Results:
Of 2,000 mailed surveys, 439 U.S. anesthesiologists responded (22%). Multivariate ordinal logistic regression analysis showed that anesthesiologists were more likely to recommend preoperative cardiology consultation for patients with more comorbidities [odds ratio = 5.53; 95% confidence interval (CI) = 3.76, 8.15], for those with poorer functional status (odds ratio = 1.45; 95% CI = 1.02, 2.07), for those undergoing a more significant surgery (odds ratio = 1.61; 95% CI = 1.13, 2.30), as the clinicians' estimated risk of perioperative myocardial infarction increased (P < 0.001), or if they only infrequently anesthetized patients such as the one described in the scenario (P = 0.05). They also would request a preoperative echocardiogram for patients with more comorbidities (odds ratio = 2.58; 95% CI = 1.80, 3.68) and for those undergoing a more significant surgery (odds ratio = 1.59; 95% CI = 1.12, 2.25). A preoperative stress test was recommended for patients with more comorbidities (odds ratio = 3.01; 95% CI = 2.06, 4.38) and for those with a more significant surgery (odds ratio = 1.74; 95% CI = 1.15, 2.63). Other factors associated with request for a preoperative stress test were female gender of the anesthesiologist (odds ratio = 1.79; 95% CI = 1.11, 2.87), those with less experience with such patients (P = 0.05), and those from New England (odds ratio = 2.16; 95% CI = 1.01, 4.62).
Conclusions:
Anesthesiologists' preferences for preoperative cardiac evaluation are generally consistent with evidence-based and expert-based AHA/ACC guidelines. However, other physician factors (ie, gender, years in practice, and familiarity with the surgical procedure) also influenced these decisions.
Related Concept Videos
01:28Cardiomyopathy VII: Pre and Post Operative Nursing Management
01:22Aneurysm IV: Nursing Management
01:23Assessment of the Cardiovascular System I: Subjective Data
Initial Enquiry
Ask the patient about their primary concern and thoroughly explore all reported symptoms.
Medical History
Investigate past illnesses affecting the cardiovascular system, such as angina, anemia, rheumatic fever, congenital heart disease, stroke, thrombophlebitis, dysrhythmias, varicosities
Inquire about symptoms...
01:23Peripheral Artery Disease V: Postoperative Nursing Management
01:26Cardiac Catheterization IV: Nursing Management
01:28Cardiac Catheterization I: Pre-Procedure Overview