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The preoperative cardiology consultation: goal settings and great expectations

Emre Aslanger1, Ibrahim Altun, Goksel Guz

  • 1Department of Cardiology, Istanbul Faculty of Medicine, Istanbul University, Capa-Istanbul, Turkey. mr_aslanger@hotmail.com

Acta Cardiologica
|September 8, 2011
PubMed

Insights

Preoperative cardiology consultations are frequently overused, leading to unnecessary tests and decreased cost-effectiveness. Applying established algorithms can help prevent unnecessary evaluations for elective surgery patients.

Area of Science:

  • Cardiology
  • Health Services Research

Background:

  • Preoperative cardiology consultation guidelines exist but their real-world effectiveness is unclear.
  • Overutilization may cause unnecessary investigations, longer hospital stays, and surgical cancellations.

Purpose of the Study:

  • Investigate the impact of the American Heart Association/American College of Cardiology algorithm.
  • Assess the algorithm's potential to prevent unnecessary preoperative evaluations.

Main Methods:

  • Retrospective analysis of 712 patients undergoing elective surgery.
  • Examined patient characteristics, consultant findings, and impact on clinical decisions/therapy.

Main Results:

  • 'Pre-operative evaluation' was the most common reason for consultation (80.9%).
  • Cardiologists identified abnormalities in 67.8% but influenced decisions in only 36.9%.
  • Applying the algorithm to routine requests revealed only 7.6% needed further investigation.

Conclusions:

  • Preoperative cardiology consultations appear overused, driven by a low threshold for requests.
  • Non-specific consultation requests lead to unnecessary investigations and reduced cost-effectiveness.
  • Cardiologists' findings often add little to clinical decision-making.
Abstract

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