Background: Preoperative assessment is a common medical practice, with latest guidelines emphasizing use of additional diagnostic testing only in patients to whom it would bring substantial change in management. The objective of our study is to determine the appropriateness of diagnostic tests used in preoperative assessment
Methods: This observational study was conducted at a 200 bed community based teaching hospital in Chicago. We performed an implicit retrospective charts review for patients who underwent inpatient surgery from June 1st, 2016 to July 31, 2016. A random sample of 120 charts (out of total number of 364) was selected. The appropriateness of pre-surgical tests was determined based on 2014 American College of Cardiology/American Heart Association guidelines.
Surgery type, total number | Echocardiogram, appropriate/total (percentage) | Stress test, appropriate/total (percentage) | Cardiac catheterization, appropriate/total (percentage) | Total tests, appropriate/total done (percentage) |
Orthopedic, 56 | 8/15 (53%) | 0/19 (0%) | 3/3 (100%) | 11/37 (30%) |
Abdominal, 13 | 2/4 (50%) | 0/2 (0%) | 0/0 | 2/6 (33%) |
Laparoscopic, 13 | 2/3 (67%) | 0/0 | 0/0 | 2/3 (67%) |
Gynecologic/urologic, | 2/3 (67%) | 0/0 | 0/1 (50%) | 2/4 (50%) |
Vascular, | 1/8 (12.5%) | 0/2 (0%) | 0/0 | 1/10 (10%) |
Plastic/reconstructive, | 1/1 (100%) | 0/0 | 0/0 | 1/1 (100%) |
Neurosurgery | 0/0 | 0/0 | 0/1 (50%) | 0/1 (50%) |
Thoracic | 2/2 (100%) | 0/0 | 0/0 | 2/2 (100%) |
Total | 18/36 (50%) | 0/23 (0%) | 3/5(60%) | 21/64 (33%)
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Table. Appropriateness of preoperative use of echocardiogram, cardiac stress test and cardiac catheterization by surgery type.
Conclusions: Our retrospective quality assessment study revealed a significant percentage (about two thirds) of inappropriate preoperative cardiac testing. Preoperative cardiac assessment in our cohort seemed subjective and based on risk factor evaluation or documentation. Surgeons also significantly contributed to overuse of clinical tests. Re-enforcement of appropriate preoperative clinical evaluation to avoid unnecessary testing is warranted.