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Published on: March 15, 2022
The Clinical Impact of Cardiology Consultation Prior to Major Vascular Surgery
Frank M Davis1, Yeo June Park, Scott F Grey
1*Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI†Division of Cardiology, Department of Medicine, University of Michigan, Ann Arbor, MI‡Section of Vascular Surgery, Department Surgery, Spectrum Health Center, Grand Rapids, MI§Section of Vascular Surgery, Department Surgery, Bronson Healthcare System, Kalamazoo, MI¶Section of Vascular Surgery, Department Surgery, Henry Ford Health System, Detroit, MI.
Insights
Preoperative cardiology consultation for vascular surgery shows significant hospital variation. While not impacting patient-level risk, high consultation rates at the hospital level correlated with reduced perioperative myocardial infarction (poMI).
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Healthcare Quality Improvement
Background:
- Preoperative medical consultation aims to mitigate risks associated with major vascular surgery.
- Evidence supporting the specific benefit of preoperative cardiology consultation in major vascular surgery remains limited.
Purpose of the Study:
- To assess statewide variations in preoperative cardiology consultations for major vascular surgery.
- To determine the association between preoperative cardiology consultation and perioperative myocardial infarction (poMI).
Main Methods:
- Utilized a statewide vascular surgery registry (2012-2014) including 5191 patients.
- Risk-stratified patients by revised cardiac risk index and compared poMI rates.
- Employed logistic regression to analyze poMI rates across hospitals based on consultation frequency.
Main Results:
- No patient-level association found between cardiology consultation and poMI after risk stratification.
- Significant hospital-level variation in consultation rates (6.9%-87.5%).
- Hospitals with high consultation rates (>66%) demonstrated a reduction in poMI (OR, 0.52; P <0.05).
Conclusions:
- Preoperative cardiology consultation rates vary widely across institutions for vascular surgery patients.
- Patient-level cardiology consultation did not correlate with poMI, but hospital-level high rates did.
- Hospital culture and broader medical service consultation may influence poMI reduction.
Objective:
To understand statewide variation in preoperative cardiology consultation prior to major vascular surgery and to determine whether consultation was associated with differences in perioperative myocardial infarction (poMI).
Summary Background Data:
Medical consultation prior to major vascular surgery is obtained to reduce perioperative risk. Despite perceived benefit of preoperative consultation, evidence is lacking specifically for major vascular surgery on the effect of preoperative cardiac consultation.
Methods:
Patient and clinical data were obtained from a statewide vascular surgery registry between January 2012 and December 2014. Patients were risk stratified by revised cardiac risk index category and compared poMI between patients who did or did not receive a preoperative cardiology consultation. We then used logistic regression analysis to compare the rate of poMI across hospitals grouped into quartiles by rate of preoperative cardiology consultation.
Results:
Our study population comprised 5191 patients undergoing open peripheral arterial bypass (n = 3037), open abdominal aortic aneurysm repair (n = 332), or endovascular aneurysm repair (n = 1822) at 29 hospitals. At the patient level, after risk-stratification by revised cardiac risk index category, there was no association between cardiac consultation and poMI. At the hospital level, preoperative cardiac consultation varied substantially between hospitals (6.9%-87.5%, P <0.001). High preoperative consulting hospitals (rate >66%) had a reduction in poMI (OR, 0.52; confidence interval: 0.28-0.98; P <0.05) compared with all other hospitals. These hospitals also had a statistically greater consultation rate with a variety of medical specialties.
Conclusions:
Preoperative cardiology consultation for vascular surgery varies greatly between institutions, and does not appear to impact poMI at the patient level. However, reduction of poMI was noted at the hospitals with the highest rate of preoperative cardiology consultation as well as a variety of medical services, suggesting that other hospital culture effects play a role.
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