APPROPRIATENESS OF PREOPERATIVE EVALUATION- A QUALITY ASSESSMENT

Marina Kovacevic, MD*1;Larissa Verda, M.D, PhD2 and Polina Pilyuyko, MD1, (1)Weiss Memorial Hospital, Chicago, IL, (2)WEISS MEMORIAL HOSPITAL, Chicago, IL

Meeting: Hospital Medicine 2017, May 1-4, 2017; Las Vegas, Nev.

Abstract number: 180

Categories: Quality Improvement, Research Abstracts

Keywords:

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.

Results: Our sample demographic characteristics were as follows: median age was 62.5 years (ranged 16-94), women/men ratio was 1.2:1. Six patients were excluded from analysis due to emergent surgery/cardiac surgery. Among 114 elective surgeries, almost half of all surgical procedures (56) were orthopedic. Electrocardiograms were done in all patients. For cardiac tests such as echocardiogram, stress test or cardiac catheterization, reviewers deemed only 33% as appropriate. None of the tests deemed inappropriate changed or affected patient management. Housestaff physicians performed the majority (67%) of preoperative evaluations (40% inpatient and 27% outpatient). Revised cardiac risk index (RCRI) score was documented only in two patients’ charts, while exercise tolerance was mentioned in three charts. One third of diagnostic tests (35/114) was requested by surgeons, though neither indicated nor recommended by internists. No adverse cardiovascular events were observed postoperatively.
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%)

 

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.

To cite this abstract:

Kovacevic, M; Verda, L; Pilyuyko, P . APPROPRIATENESS OF PREOPERATIVE EVALUATION- A QUALITY ASSESSMENT. Abstract published at Hospital Medicine 2017, May 1-4, 2017; Las Vegas, Nev. Abstract 180. Journal of Hospital Medicine. 2017; 12 (suppl 2). https://www.shmabstracts.com/abstract/appropriateness-of-preoperative-evaluation-a-quality-assessment/. Accessed May 20, 2019.

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