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Preoperative cardiology consult not linked to postoperative morbidity in AAA repair
In patients undergoing elective abdominal aortic aneurysm repair, preoperative cardiology consultation does not appear to be linked to postoperative cardiac morbidity after controlling for patient disease severity, according to recent findings.
In the retrospective review, researchers evaluated 469 patients (mean age, 72 years; 20% women) who were treated with elective AAA repair, either endovascular or surgical, between June 2007 and July 2014. Patient and procedural data collected included medical history, preoperative cardiology consultation and postoperative complications.
Thirty-day morbidity, consult-specific morbidity and mortality were designated as the study’s primary outcomes. The researchers estimated a bivariate probit regression model accounting for the endogeneity of binary preoperative medical consult, and estimated patient variability with a maximum likelihood function.
They found that 80 patients (17.4%) had preoperative medical consults. Although a variety of medical specialties were contacted for preoperative consults, most (85%) were cardiology consults. Hyperlipidemia, increased aneurysm size and increased revised cardiac risk increased the likelihood of preoperative referral to cardiology. The average AAA size was 5.82 ± 1.13 cm. AAAs were repaired with open intervention in 161 patients, and with endovascular treatment in the reminder of patients.
Compared with patients who underwent open surgical AAA repair, a lower proportion of those who underwent endovascular repair received preoperative consultation.
Of patients referred to preoperative cardiology consultation, nearly all patients underwent an ECG (n = 66), whereas fewer were tested with invasive procedures such as cardiac catheterization (n = 7), stress test (n = 24) or transthoracic echocardiogram (n = 5).
After controlling for revised cardiac risk index, the researchers found no difference by procedure type in postoperative complications (P = .295). An analysis controlled for patient comorbidities found no difference in postoperative cardiac-related complications between patents who were referred vs. those not referred for preoperative cardiology consultation (P = .386).
“Our findings suggest that preoperative cardiac consultation prior to [AAA] repair does not alter postoperative morbidity,” the researchers wrote. “Additional studies are warranted to further hospital characteristics and culture that underlies preoperative cardiology consultation, as well as understanding the impact on health care cost of preoperative cardiology consultation prior to AAA repair.” – by Jennifer Byrne
Disclosure: The researchers report no relevant financial disclosures.