Accepted for/Published in: JMIR Perioperative Medicine
Date Submitted: Jun 9, 2024
Date Accepted: Aug 6, 2024
Novel electronic form for preoperative cardiac risk assessment is associated with reduction in cardiac consultations and testing: A Retrospective cohort study
ABSTRACT
Background:
Preoperative cardiac risk assessment is an integral part of preoperative evaluation; however, there is significant variation among providers, leading to inappropriate referrals for cardiology consultation or excessive low-value cardiac testing. We implemented a novel electronic medical record (EMR) form in our preoperative clinics to decrease variation.
Objective:
Investigate the impact of the EMR form on the preoperative utilization of cardiology consultation and cardiac diagnostic testing (echocardiograms, stress tests, and cardiac catheterization) and evaluate postoperative outcomes.
Methods:
Retrospective cohort study of elective surgical patients who underwent outpatient preoperative evaluation over 2 years divided into two cohorts: July 1, 2021, to June 30, 2022 (pre-EMR form implementation) and July 1, 2022, to June 30, 2023 (post-EMR form implementation). Demographics, comorbidities, resource utilization, and surgical characteristics were analyzed. Propensity score matching was used to adjust for differences between the two cohorts. The primary outcomes were utilization of preoperative cardiology consultation, cardiac testing, and 30-day postoperative major adverse cardiac events (MACE).
Results:
25,484 patients met inclusion criteria. Propensity score-matching yielded 11,654 well-matched pairs. The post-EMR matched cohort had lower cardiology consultation [pre = 2698 (23.2%) vs. post = 2088 (17.9%), p <0.001] and echocardiogram [pre = 808 (6.9%) vs. post = 591 (5.1%), p <0.001] utilization. There were no significant differences in the 30-day postoperative outcomes, including MACE. While patients with “Possible indications for cardiology consultation had higher MACE rates, the consultations did not reduce MACE risk. Most algorithm endpoints, except for active cardiac conditions, had MACE rates < 1%.
Conclusions:
In this cohort study, preoperative cardiac risk assessment using a novel EMR form was associated with a significant decrease in cardiology consultation and testing utilization, with no adverse impact on postoperative outcomes. Adopting this approach may assist perioperative medicine clinicians and anesthesiologists in efficiently decreasing unnecessary preoperative resource utilization without compromising patient safety or quality of care.
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