The following is the summary of “Frequency and Predictors of Preoperative Cardiac Testing Overuse in Low-Risk Patients Before Laparoscopic Bariatric Surgery,” published in the January 2023 issue of Cardiovascular Disease by King, et al.

Despite the low incidence of cardiac complications following laparoscopic bariatric surgery, low-risk patients are often subjected to unnecessary preoperative cardiology examination and testing. Their goal was to determine how often patients with minimal cardiac risk have unnecessary preoperative cardiac testing prior to laparoscopic bariatric surgery and what factors might account for this. In addition, the 1,094 adult patients who underwent laparoscopic bariatric surgery at our institution between January 1, 2015, and December 31, 2019, were reviewed retrospectively. 

The National Surgical Quality Improvement Program Myocardial Infarction and Cardiac Arrest (NSQIP MICA) risk model and the Revised Cardiac Risk Index (RCRI) were used to calculate cardiac risk. Overuse of cardiac testing in low-risk patients was analyzed using multivariate logistic regression. Overall, the RCRI determined that 1,059 (96.8%) patients were at low cardiac risk, while the NSQIP MICA determined 1,094 (100%). About 587 patients (51.8%) were sent to cardiology for preoperative examination, and 643 patients (56.7%) had some heart test done before surgery. Overuse of preoperative cardiac testing in low-risk patients was linked with preoperative cardiology referral (adjusted odds ratio 37.2, 95% CI 25.3 to 54.7) and patient age (adjusted odds ratio 1.05, 95% CI 1.03 to 1.07). 

Patients at low heart risk before laparoscopic bariatric surgery were often subjected to unnecessary preoperative cardiac testing. The most important risk factor connected to excessive preoperative cardiac testing was a referral to cardiology before surgery. If risk models like the RCRI or NSQIP MICA are used at the time of bariatric program enrolment, it may be possible to reduce the number of low-risk individuals who have needless preoperative cardiac testing.

Source: sciencedirect.com/science/article/abs/pii/S0002914922010451