Preoperative cardiology referral practices at a tertiary care centre: A retrospective observational study

Background Preoperative consultations and testing add to healthcare costs. Unnecessary consultations lead to further testing and delay in surgery. Guidelines help us in clinical practice but are seldom followed. We studied the appropriateness of our preoperative cardiology referrals according to the guidelines and functional utility of the consultations. Methods We reviewed the records of patients who underwent elective non-cardiac surgery to identify those who had a preoperative cardiology consult. Appropriateness of the referral was assessed by comparing with the 2014 American College of Cardiology/American Heart Association guidelines. Any recommendations made, major adverse cardiac events and perioperative outcome were also noted. Results Only 71 (15.5%) referrals were appropriate according to the guidelines. A majority of them were for preoperative clearance. The most common recommendation was to withhold antiplatelet medications. None of the consultations made any change in the anaesthetic or surgical plan. Six patients had major perioperative adverse cardiac events. Conclusion The majority of consultations were by surgeons and were not indicated according to the guidelines and did not have any impact on patient outcome. A large proportion of these patients had low cardiac risk index. As anaesthesiologists, we are best equipped to quantify risk and optimize a patient and should be the leaders of the perioperative period.