Evaluation of Appropriate Use of Preoperative Echocardiography before Major Abdominal Surgery: A Retrospective Cohort Study.
Evaluation of Appropriate Use of Preoperative Echocardiography before Major Abdominal Surgery: A Retrospective Cohort Study.
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DOI：
10.1097/aln.0000000000003984
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发表时间：
2021-11-01
期刊：
影响因子：
8.8
通讯作者：
Rubin DS
中科院分区：
文献类型：
--
作者：
Tank A;Hughey R;Ward RP;Nagele P;Rubin DS
术前静息超声心动图检查通常在非心脏手术之前进行，但术前静息超声心动图检查的适应症有限。我们的研究旨在使用超声心动图适当使用标准来调查术前静息超声心动图的适当性，其中包括围手术期心血管评估和管理指南中的指征以及独立于围手术期的非围手术期指征。我们假设患者经常在没有适当指征的情况下接受检测。 Truven Health MarketScan 商业和医疗保险补充数据库中包含 2005 年至 2017 年接受过腹部重大手术的患者记录。这些数据库包含超过 2.5 亿患者的去识别化医疗服务记录，这些患者通过基于雇主的按次服务收费、服务点或按人头计划享受基本或医疗保险补充健康保险。根据手术后 60 天内门诊患者要求进行静息经胸超声心动图检查的情况对患者进行分类。适当性是通过与权利要求相关的国际疾病分类第九次/第十次修订临床修改 (ICD-9/10-CM) 主要和次要诊断代码来确定的，并使用超声心动图适当使用标准将其分类为“适当”、“很少适当”或“不可分类”。在我们队列的 230,535 名患者中，6.0% (13,936) 的患者进行了术前静息经胸超声心动图检查。有 12,638 项（91%）研究可按适当使用标准分类，1,298 项（9%）研究无法分类。在可分类的研究中，8,959 项（71%）被认为“适当”，而 3,679 项（29%）被认为“很少适当”。慢性缺血性心脏病和无并发症高血压的监测占“很少合适”超声心动图的 43% (1588/3679)。根据适当使用标准，超过四分之一的术前静息超声心动图被认为“很少合适”。一小部分患者特征占“很少合适”的术前静息超声心动图的很大一部分。
Preoperative resting echocardiography is often performed prior to non-cardiac surgery, but indications for preoperative resting echocardiography are limited. Our study aims to investigate appropriateness of preoperative resting echocardiography using the Appropriate Use Criteria for Echocardiography, which encompass indications from the guidelines on perioperative cardiovascular evaluation and management and non-perioperative indications independent of the perioperative period. We hypothesize that patients are frequently tested without an appropriate indication. Records of patients in the Truven Health MarketScan Commercial and Medicare Supplemental Databases who underwent a major abdominal surgery from 2005–2017 were included. These databases contain de-identified records of health services for more than 250 million patients with primary or Medicare supplemental health insurance coverage through employer-based fee-for-service, point-of-service, or capitated plans. Patients were classified based on the presence of an outpatient claim for resting transthoracic echocardiography within 60 days of surgery. Appropriateness was determined via International Classification of Disease, Ninth/Tenth Revision-Clinical Modification (ICD-9/10-CM) principal and secondary diagnosis codes associated with the claims, and classified as “appropriate,” “rarely appropriate,” or “unclassifiable” using the Appropriate Use Criteria for Echocardiography. Among 230,535 patients in our cohort, preoperative resting transthoracic echocardiography was performed in 6.0% (13,936) of patients. There were 12,638 (91%) studies classifiable by the Appropriate Use Criteria, and 1,298 (9%) were unable to be classified. Among the classifiable studies, 8,959 (71%) were deemed “appropriate” while 3,679 (29%) were deemed “rarely appropriate.” Surveillance of chronic ischemic heart disease and uncomplicated hypertension accounted for 43% (1588/3679) of “rarely appropriate” echocardiograms. More than one in four preoperative resting echocardiograms were considered “rarely appropriate” according to the Appropriate Use Criteria. A narrow set of patient characteristics account for a large proportion of “rarely appropriate” preoperative resting echocardiograms.