Last-minute preoperative cardiology consultations: epidemiology and impact

To identify clinical predictors of last-minute preoperative cardiology consultations and to evaluate the impact of these consultations on patient care, we performed a retrospective case-control study including all 166 patients who received unscheduled cardiology consultations at the preadmission testing center (PATC) of an urban teaching hospital. Control subjects were 166 patients matched by date and category of surgical procedure. Significant (p < 0.05) independent predictors of last-minute consultations included history of myocardial infarction (odds ratio [OR] = 23.7; 95% confidence interval [CI] = 1.5 to 373), history of chest pain (OR = 15.3; 95% CI = 3.7 to 62.9), history of chronic obstructive lung disease (OR = 5.9; 95% CI = 1.1 to 32.9), prior echocardiography (OR = 3.4; 95% CI = 1.2 to 9.8), and age (OR per decade = 1.1; 95% CI = 1.04 to 1.1). Thus among patients undergoing elective noncardiac surgery, last-minute preoperative consultations are common and are usually precipitated by an abnormal electrocardiogram or history of cardiovascular disease. Last-minute consultations may be preventable if those patients with risk factors for consultation are identified in advance of the preadmission evaluation and referred for elective consultation.