Increased Preoperative Stress Test Utilization is Not Associated With Reduced Adverse Cardiac Events in Current US...

Area of Science:

• Cardiology
• Health Services Research
• Perioperative Medicine

Background:

• Significant variation exists in preoperative stress testing practices across US healthcare centers.
• The association between the frequency of preoperative stress testing and perioperative cardiac events remains unclear.

Purpose of the Study:

• To assess the frequency of preoperative stress testing in patients undergoing major elective surgery.
• To determine if higher rates of preoperative stress testing correlate with reduced perioperative cardiac events.

Main Methods:

• Analysis of data from 185,612 patients undergoing 8 types of major elective surgery (general, vascular, oncologic) between 2015-2019.
• Centers were categorized into quintiles based on their preoperative stress testing frequency.
• Comparison of in-hospital major adverse cardiac events (MACE), myocardial infarction (MI), and costs across these quintiles, adjusting for patient risk using the modified revised cardiac risk index (mRCRI).

Main Results:

• Preoperative stress testing varied widely, from 1.7% to 22.5% across centers, despite similar patient risk profiles (mRCRI > 1: 15.0% vs 15.8%).
• In-hospital MACE rates were lower in centers with the lowest stress testing frequency (8.2%) compared to the highest (9.4%).
• Myocardial infarction (MI) rates were similar across all quintiles (0.5%). Significant cost differences were observed, with higher testing centers incurring substantially more expense ($357,300 vs $26,996 per 1000 patients).

Conclusions:

• Substantial variation in preoperative stress testing persists nationally, irrespective of patient risk.
• Higher rates of preoperative stress testing are not linked to decreased perioperative MACE or MI.
• Selective stress testing may offer opportunities for cost reduction by minimizing unnecessary procedures.