title: The effects of preoperative cardiology consultation prior to elective abdominal aortic aneurysm repair on patient morbidity.
abstract: Objectives The relationship between preoperative medical consultations and postoperative complications has not been extensively studied. Thus, we investigated the impact of preoperative consultation on postoperative morbidity following elective abdominal aortic aneurysm repair. Methods A retrospective review was conducted on 469 patients (mean age 72 years, 20% female) who underwent elective abdominal aortic aneurysm repair from June 2007 to July 2014. Data elements included detailed medical history, preoperative cardiology consultation, and postoperative complications. Primary outcomes included 30-day morbidity, consult-specific morbidity, and mortality. A bivariate probit regression model accounting for the endogeneity of binary preoperative medical consult and patient variability was estimated with a maximum likelihood function. Results Eighty patients had preoperative medical consults (85% cardiology); thus, our analysis focuses on the effect of cardiac-related preoperative consults. Hyperlipidemia, increased aneurysm size, and increased revised cardiac risk index increased likelihood of referral to cardiology preoperatively. Surgery type (endovascular versus open repair) was not significant in development of postoperative complications when controlling for revised cardiac risk index ( p = 0.295). After controlling for patient comorbidities, there was no difference in postoperative cardiac-related complications between patients who did and did not undergo cardiology consultation preoperatively ( p = 0.386). Conclusions When controlling for patient disease severity using revised cardiac risk index risk stratification, preoperative cardiology consultation is not associated with postoperative cardiac morbidity.
authors.affiliation: Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Anna E
authors.initials: AE
authors.lastname: Boniakowski
authors.affiliation: Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Frank M
authors.initials: FM
authors.lastname: Davis
authors.affiliation: Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Amanda R
authors.initials: AR
authors.lastname: Phillips
authors.affiliation: Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Adina B
authors.initials: AB
authors.lastname: Robinson
authors.affiliation: Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Dawn M
authors.initials: DM
authors.lastname: Coleman
authors.affiliation: Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Peter K
authors.initials: PK
authors.lastname: Henke
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D002309:Cardiology; D017558:Elective Surgical Procedures; D005260:Female; D006331:Heart Diseases / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000209:etiology; D011237:Predictive Value of Tests; D012017:Referral and Consultation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality
keywords: Vascular disease; cardiovascular surgery; quality and outcomes; treatment