title: The preoperative cardiology consultation: goal settings and great expectations.
abstract: BACKGROUND
  Despite the availability of guidelines for preoperative cardiology consultations, their efficacy in real clinical practice remains unknown. Furthermore, there are concerns that overused cardiology consultations can lead to unnecessary investigations, prolonged hospital stays, and even cancellation of necessary surgery. In this retrospective study, we investigated: (i) the potential impact of the American Heart Association/American College of Cardiology algorithm and (ii) the potential of this algorithm for preventing unnecessary evaluation.
  
  
  METHODS
  We examined the cardiology consultation requests for 712 patients scheduled for elective surgery. Our analysis included: (i) patient characteristics, (ii) abnormalities revealed by the consultant, (iii) impact of these abnormalities on clinical decision making and therapy modification.
  
  
  RESULTS
  The most common reason for consultation was 'pre-operative evaluation' (80.9%). Although our cardiologists revealed an abnormality in 67.8% and recommended further work up in 58.7% of our patients, they contributed to the clinical course in only 36.9%. Moreover, when the algorithm was applied to 'routine pre-operative evaluation' requests lacking a specific question, only 7.6% of these consultation requests required further investigation.
  
  
  CONCLUSIONS
  Preoperative cardiology consultation seems to be overused. Although the fear of missing important issues leads surgeons to use a decreased threshold for pre-operative consultation requests, such a non-specific manner of pre-operative consultation request causes unnecessary investigations and decreased cost-effectiveness. Furthermore, the detection of any clinical abnormality by cardiologists surprisingly adds little to clinical decision making.
authors: Department of Cardiology, Istanbul Faculty of Medicine, Istanbul University, Capa-Istanbul, Turkey. mr_aslanger@hotmail.com
authors: Emre
authors: E
authors: Aslanger
authors: Ibrahim
authors: I
authors: Altun
authors: Goksel
authors: G
authors: Guz
authors: Omer
authors: O
authors: Kiraslan
authors: Nihat
authors: N
authors: Polat
authors: Ebru
authors: E
authors: Golcuk
authors: Huseyin
authors: H
authors: Oflaz
mesh_terms: D000368:Aged; D002309:Cardiology; D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D057234:Preoperative Period; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative