Low-value preoperative cardiac testing before low-risk surgical procedures: a population-based cohort study

Area of Science:

• Cardiology
• Health Services Research
• Public Health

Background:

• Choosing Wisely Canada (CWC) advises against routine noninvasive advanced cardiac testing for low-risk noncardiac surgery.
• Preoperative assessment guidelines aim to reduce low-value healthcare utilization.

Purpose of the Study:

• To evaluate temporal trends in preoperative advanced cardiac testing (exercise stress testing, echocardiography, myocardial perfusion imaging) following CWC recommendations.
• To identify patient and provider factors associated with low-value cardiac testing in low-risk surgical patients.

Main Methods:

• Population-based retrospective cohort study using linked health administrative data in Alberta, Canada (2011-2019).
• Included adult patients undergoing elective noncardiac surgery with preoperative advanced cardiac tests within 6 months.
• Excluded high-risk patients (Revised Cardiac Risk Index ≥ 1); analyzed electrocardiography as an exploratory outcome.

Main Results:

• 2.1% of 1,045,896 operations were preceded by advanced cardiac testing.
• Testing incidence increased from 2011/12 to 2018/19 (1.3 times more likely).
• Urban patients were more likely to receive tests; electrocardiography was most common (17.4%).

Conclusions:

• Preoperative advanced cardiac testing remains infrequent but shows an increasing trend despite CWC guidelines.
• Significant geographic variation in testing exists, suggesting suboptimal adherence to recommendations.
• Further interventions may be needed to align practice with evidence-based guidelines for low-risk surgical patients.