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Cost conscious care: preoperative evaluation by a cardiologist prior to low-risk procedures
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 consecutiv...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6567947/ https://www.ncbi.nlm.nih.gov/pubmed/31259281 http://dx.doi.org/10.1136/bmjoq-2018-000481 |
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author | Coffman, Joseph Tran, Thanh Quast, Troy Berlowitz, Michael S Chae, Sanders H |
author_facet | Coffman, Joseph Tran, Thanh Quast, Troy Berlowitz, Michael S Chae, Sanders H |
author_sort | Coffman, Joseph |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-6567947 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-65679472019-06-28 Cost conscious care: preoperative evaluation by a cardiologist prior to low-risk procedures Coffman, Joseph Tran, Thanh Quast, Troy Berlowitz, Michael S Chae, Sanders H BMJ Open Qual Original Article 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. BMJ Publishing Group 2019-06-12 /pmc/articles/PMC6567947/ /pubmed/31259281 http://dx.doi.org/10.1136/bmjoq-2018-000481 Text en © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/. |
spellingShingle | Original Article Coffman, Joseph Tran, Thanh Quast, Troy Berlowitz, Michael S Chae, Sanders H Cost conscious care: preoperative evaluation by a cardiologist prior to low-risk procedures |
title | Cost conscious care: preoperative evaluation by a cardiologist prior to low-risk procedures |
title_full | Cost conscious care: preoperative evaluation by a cardiologist prior to low-risk procedures |
title_fullStr | Cost conscious care: preoperative evaluation by a cardiologist prior to low-risk procedures |
title_full_unstemmed | Cost conscious care: preoperative evaluation by a cardiologist prior to low-risk procedures |
title_short | Cost conscious care: preoperative evaluation by a cardiologist prior to low-risk procedures |
title_sort | cost conscious care: preoperative evaluation by a cardiologist prior to low-risk procedures |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6567947/ https://www.ncbi.nlm.nih.gov/pubmed/31259281 http://dx.doi.org/10.1136/bmjoq-2018-000481 |
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