Anesthesiologists' preferences for preoperative cardiac evaluation before vascular surgery: results of a mail survey.
OBJECTIVE
To investigate whether anesthesiologists' decisions to request preoperative cardiac evaluation (cardiologist consultation, echocardiography, and cardiac stress testing) before vascular surgery were influenced by patient comorbidity and magnitude of surgery; and to explore whether factors unrelated to the American College of Cardiology/American Heart Association (ACC/AHA) guidelines influence these decisions.


METHODS
Survey instrument.


METHODS
University medical center.


METHODS
2,000 U.S. anesthesiologists who were mailed a survey.


METHODS
Six factors in a hypothetical patient presenting for vascular surgery [gender, race (white vs. black), age (65 yrs vs. 85 yrs), comorbidities (sick vs. healthy), functional status, and magnitude of surgical stress] were evaluated. Respondents were asked about their demographics, practice patterns, and how they would manage the hypothetical patient.


RESULTS
Of 2,000 mailed surveys, 439 U.S. anesthesiologists responded (22%). Multivariate ordinal logistic regression analysis showed that anesthesiologists were more likely to recommend preoperative cardiology consultation for patients with more comorbidities [odds ratio = 5.53; 95% confidence interval (CI) = 3.76, 8.15], for those with poorer functional status (odds ratio = 1.45; 95% CI = 1.02, 2.07), for those undergoing a more significant surgery (odds ratio = 1.61; 95% CI = 1.13, 2.30), as the clinicians' estimated risk of perioperative myocardial infarction increased (P < 0.001), or if they only infrequently anesthetized patients such as the one described in the scenario (P = 0.05). They also would request a preoperative echocardiogram for patients with more comorbidities (odds ratio = 2.58; 95% CI = 1.80, 3.68) and for those undergoing a more significant surgery (odds ratio = 1.59; 95% CI = 1.12, 2.25). A preoperative stress test was recommended for patients with more comorbidities (odds ratio = 3.01; 95% CI = 2.06, 4.38) and for those with a more significant surgery (odds ratio = 1.74; 95% CI = 1.15, 2.63). Other factors associated with request for a preoperative stress test were female gender of the anesthesiologist (odds ratio = 1.79; 95% CI = 1.11, 2.87), those with less experience with such patients (P = 0.05), and those from New England (odds ratio = 2.16; 95% CI = 1.01, 4.62).


CONCLUSIONS
Anesthesiologists' preferences for preoperative cardiac evaluation are generally consistent with evidence-based and expert-based AHA/ACC guidelines. However, other physician factors (ie, gender, years in practice, and familiarity with the surgical procedure) also influenced these decisions.
Ellis
John E
JE
Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA. johnellis1700@gmail.com
Tung
Avery
A
Lee
Helen
H
Lee
Hubert
H
Kasza
Kristen
K
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000776:Anesthesiology / Q000379:methods*; D002318:Cardiovascular Diseases / Q000150:complications / Q000175:diagnosis; D003625:Data Collection; D004452:Echocardiography / Q000379:methods; D019317:Evidence-Based Medicine; D005080:Exercise Test / Q000379:methods; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000517:prevention & control; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011300:Preoperative Care / Q000379:methods*; D012307:Risk Factors; D014481:United States; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000379:methods*