Key result
Preoperative echocardiograms before major abdominal surgery are rarely appropriate in ~29% of cases.
Why the study?
Preoperative resting echocardiography is frequently performed before noncardiac surgery despite limited indications, raising concern that patients are tested without an appropriate indication.
What is the appropriateness of preoperative resting echocardiography before major abdominal surgery according to the Appropriate Use Criteria?
Cohort (n=230,535)
What is the appropriateness of preoperative resting echocardiography before major abdominal surgery according to the Appropriate Use Criteria?
More than one in four preoperative resting echocardiograms before major abdominal surgery are considered 'rarely appropriate' according to the Appropriate Use Criteria.
Suggests frequent rarely appropriate preoperative echocardiography use; leaves open whether appropriateness criteria improve resource use or outcomes.
BACKGROUND: Preoperative resting echocardiography is often performed before noncardiac surgery, but indications for preoperative resting echocardiography are limited. This study aimed to investigate appropriateness of preoperative resting echocardiography using the Appropriate Use Criteria for Echocardiography, which encompass indications from the guidelines on perioperative cardiovascular evaluation and management and nonperioperative indications independent of the perioperative period. The authors hypothesized that patients are frequently tested without an appropriate indication. METHODS: Records of patients in the Truven Health MarketScan Commercial and Medicare Supplemental Databases who underwent a major abdominal surgery from 2005 to 2017 were included. These databases contain de-identified records of health services for more than 250 million patients with primary or Medicare supplemental health insurance coverage through employer-based fee-for-service, point-of-service, or capitated plans. Patients were classified based on the presence of an outpatient claim for resting transthoracic echocardiography within 60 days of surgery. Appropriateness was determined via International Classification of Diseases, Ninth Revision-Clinical Modification, and International Classification of Diseases, Tenth Revision-Clinical Modification principal and secondary diagnosis codes associated with the claims, and classified as "appropriate," "rarely appropriate," or "unclassifiable" using the Appropriate Use Criteria for Echocardiography. RESULTS: Among 230,535 patients in the authors' cohort, preoperative resting transthoracic echocardiography was performed in 6.0% (13,936) of patients. There were 12,638 (91%) studies classifiable by the Appropriate Use Criteria for Echocardiography, and 1,298 (9%) were unable to be classified. Among the classifiable studies, 8,959 (71%) were deemed "appropriate," while 3,679 (29%) were deemed "rarely appropriate." Surveillance of chronic ischemic heart disease and uncomplicated hypertension accounted for 43% (1,588 of 3,679) of "rarely appropriate" echocardiograms. CONCLUSIONS: More than one in four preoperative resting echocardiograms were considered "rarely appropriate" according to the Appropriate Use Criteria for Echocardiography. A narrow set of patient characteristics accounts for a large proportion of "rarely appropriate" preoperative resting echocardiograms.
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Tank et al. (2021) conducted a cohort in Major abdominal surgery (n=230,535). Preoperative resting echocardiography was evaluated on Presence of a rarely appropriate resting echocardiogram among classifiable studies. Among patients undergoing major abdominal surgery, 29% of classifiable preoperative resting echocardiograms were considered rarely appropriate according to the Appropriate Use Criteria.
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