Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
Johns Hopkins Carey School of Business, Baltimore, Maryland, USA.
J Hosp Med. 2023 Nov;18(11):1021-1033. doi: 10.1002/jhm.13206. Epub 2023 Sep 20.
Overuse of preoperative cardiac testing contributes to high healthcare costs and delayed surgeries. A large body of research has evaluated factors associated with variation in preoperative cardiac testing. However, patient, provider, and system-level factors associated with variation in testing have not been systematically studied.
To conduct a systematic review to better delineate the patient, provider, and system-level factors associated with variation in preoperative cardiac testing.
We included studies of an adult US population evaluating a patient, provider, or system-level factor associated with variation in preoperative cardiac testing for noncardiac surgery since 2012. Our search strategy used terms related to preoperative testing, diagnostic cardiac tests, and care variation with Ovid MEDLINE and Embase from inception through January 2023. We extracted study characteristics and factors associated with variation and qualitatively analyzed them. We assessed risk of bias using the Newcastle-Ottawa Scale and Evidence Project Risk of Bias tool.
Twenty-eight articles met inclusion criteria. Older age and higher comorbidity were strongly associated with higher-intensity testing. The evidence for provider and system-level covariates was weaker. However, there was strong evidence that a focus on primary care and away from preoperative clinic and cardiac consultations was associated with less testing and that interventions to reduce low-value testing can be successful.
There is significant interprovider and interhospital variation in preoperative cardiac testing, the correlates of which are not well-defined. Further work should aim to better understand these factors.
术前心脏检查的过度使用导致了高昂的医疗保健费用和手术延迟。大量研究评估了与术前心脏检查的差异相关的因素。然而，与检查差异相关的患者、提供者和系统层面的因素尚未得到系统研究。
进行系统综述，以更好地描述与术前心脏检查差异相关的患者、提供者和系统层面的因素。
我们纳入了自 2012 年以来评估与非心脏手术术前心脏检查差异相关的患者、提供者或系统层面因素的美国成年人群研究。我们的搜索策略使用了与术前检查、诊断性心脏检查和护理差异相关的术语，在 Ovid MEDLINE 和 Embase 中进行了从开始到 2023 年 1 月的检索。我们提取了与变异相关的研究特征和因素，并进行了定性分析。我们使用纽卡斯尔-渥太华量表和 Evidence Project 风险偏倚工具评估了风险偏倚。
28 篇文章符合纳入标准。年龄较大和合并症较高与高强度检查密切相关。关于提供者和系统层面协变量的证据较弱。然而，有强有力的证据表明，关注初级保健而不是术前诊所和心脏咨询与检查较少有关，并且可以成功实施减少低价值检查的干预措施。
术前心脏检查存在显著的提供者间和医院间差异，其相关因素尚未明确。进一步的研究应旨在更好地理解这些因素。
