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Cost conscious care: preoperative evaluation by a cardiologist prior to low-risk procedures
  1. Joseph Coffman1,
  2. Thanh Tran2,
  3. Troy Quast3,
  4. Michael S Berlowitz4,5,
  5. Sanders H Chae4,5
  1. 1Department of Internal Medicine, University of South Florida, Tampa, Florida, USA
  2. 2Department of Surgery, University of South Florida, Tampa, Florida, USA
  3. 3School of Public Health, University of South Florida, Tampa, Florida, USA
  4. 4Department of Cardiology, University of South Florida, Tampa, Florida, USA
  5. 5Division of Cardiology, Tampa General Hospital, Tampa, Florida, USA
  1. Correspondence to Dr Sanders H Chae; schae{at}health.usf.edu

Abstract

Background Preoperative testing before low-risk procedures remains overutilised. Few studies have looked at factors leading to increased testing. We hypothesised that consultation to a cardiologist prior to a low-risk procedure leads to increased cardiac testing.

Methods and results 907 consecutive patients who underwent inpatient endoscopy/colonoscopy at a single academic centre were identified. Of those patients, 79 patients (8.7%) received preoperative consultation from a board certified cardiologist. 158 control patients who did not receive consultation from a cardiologist were matched by age and gender. Clinical and financial data were obtained from chart review and hospital billing. Logistic and linear regression models were constructed to compare the groups. Patients evaluated by a cardiologist were more likely to receive preoperative testing than patients who did not undergo evaluation with a cardiologist (OR 47.5, (95% CI 6.49 to 347.65). Specifically, patients seen by a cardiologist received more echocardiograms (60.8% vs 22.2%, p<0.0001) and 12-lead electrocardiograms (98.7% vs 54.4%, p<0.0001). There was a higher rate of ischaemic evaluations in the group evaluated by a cardiologist, but those differences did not achieve statistical significance. Testing led to longer length of stay (4.35 vs 3.46 days, p=0.0032) in the cohort evaluated by a cardiologist driven primarily by delay to procedure of 0.76 days (3.14 vs 2.38 days, p=0.001). Estimated costs resulting from the longer length of stay and increased testing was $10 624 per patient. There were zero major adverse cardiac events in either group.

Conclusion Preoperative consultation to a cardiologist before a low-risk procedure is associated with more preoperative testing. This preoperative testing increases length of stay and cost without affecting outcomes.

  • preoperative cardiac consultation
  • overutilisation

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Footnotes

  • Contributors JC: performed the primary data collection and analysis and wrote the primary draft of the manuscript. TT: performed statistical analysis of the data. TQ: performed statistical review of the data. MSB: reviewed and edited the final manuscript. SHC: planned the study, wrote the final draft of the manuscript and submitted the study; responsible for the overall content of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

  • Patient consent for publication Not required.

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