Background: The healthcare system in the United States is often times costly and inefficient. Some estimates suggest that 20-34% of healthcare dollars are spent ineffectively. Despite efforts such as the Choosing Wisely Campaign to limit preoperative testing prior to low risk surgery, preoperative cardiac testing before low risk procedures remains common. This study assesses the frequency, outcomes, and length of stay associated with inpatient preoperative cardiology consultation prior to low risk inpatient procedures.
Methods: 1,284 consecutive patients underwent inpatient endoscopy or colonoscopy between Nov 1, 2011 and Apr 31, 2016 at a single academic tertiary referral center. 79 patients (6.2%) underwent preoperative consultation with a board certified cardiologist. 158 patients who did not undergo inpatient cardiology consultation prior to the procedure were matched to cases by age and gender in a 2:1 ratio. Retrospective chart review of clinical, demographic and economic variables was performed.
Results: Patients with cardiology consultation were more likely to have coronary artery disease (32.9% vs 11.4%, p < 0.0001) but were similar with respect to other comorbidities. There were no differences in adverse cardiac events between the two groups. Patients who were seen by a cardiologist had a longer length of stay (4.35 days vs 3.46 days, p = 0.0032) and delay from admission to procedure (3.14 days vs 2.38 days, p = .001).
Conclusions: Preoperative cardiac evaluation prior to low risk procedures remains common. Inpatient consultation to a cardiologist for pre-procedure evaluation generates a substantial increase in length of stay and length from admission to endoscopy. Further research into the reasons for persistent referral to cardiologists and overutilization of preoperative testing is needed to understand how to implement recommendations made by campaigns such as Choosing Wisely.