Current practice in the preoperative evaluation of patients undergoing major vascular surgery: A survey of cardiovascular anesthesiologists

Abstract

Various cardiovascular testing modalities have been proposed as a means of reducing perioperative risk in patients undergoing vascular surgery. It is currently unknown with what frequency and under what conditions these tests are used in clinical practice. In an attempt to determine the spectrum of current clinical practice, the authors surveyed anesthesiologists who attended the 1992 Society of Cardiovascular Anesthesiologists Annual Meeting. A total of 77 of 100 surveys were returned, representing 58 institutions in the United States: 26 university hospitals, 29 private hospitals, 2 Veterans Administration hospitals, and 1 military hospital. The incidence of preoperative testing was not significantly different between private and university institutions, and ranged from a mean of 54% of patients undergoing lower extremity procedures to 73% of patients undergoing aortic surgery, with a wide disparity among institutions. Dipyridamole or exercise thallium imaging was the most common test used, and Holter monitoring was the least common. The testing led to revascularization in 52% of university and 72% of private hospitals. Testing was thought to result in modification of perioperative monitoring in 85% of the institutions and in modification of other aspects of care in a significant percentage of institutions. In conclusion, in this random population, preoperative testing was reported to be used in a significant percentage of patients, and similar practices were found between university and private institutions. The practices at the individual institutions and types of tests ordered varied greatly, and suggest the need for further research to determine optimal preoperative strategies.