Perioperative cardiac evaluation of simulated patients by practicing anesthesiologists is not consistent with 2007 ACC/AHA guidelines

• Published in: Journal of clinical anesthesia Vol. 24; no. 6; pp. 446 - 455
• Main Authors: Vigoda, Michael M., Behrens, Vicente, Miljkovic, Nikola, Arheart, Kristopher L., Lubarsky, David A., Dutton, Richard P.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2012; Elsevier Limited
• Subjects: Academic Medical Centers; Age; Algorithms; Anesthesia; Anesthesia & Perioperative Care; Anesthesiologists; Anesthesiology; Anesthesiology - methods; Anesthesiology - standards; Anesthesiology - statistics & numerical data; Confidence intervals; Cost-effective care; Directors; Guideline Adherence; Guidelines; Health Care Surveys; Humans; Pain Medicine; Perioperative Care - methods; Perioperative Care - standards; Perioperative Care - statistics & numerical data; Practice Guidelines as Topic; Preoperative evaluation; Programming languages; Societies, Medical; Surgery; Time Factors; United States; United States; Guideline adherence; Anesthesiologists; Cost-effective care; Preoperative evaluation; Guidelines
• ISSN: 0952-8180; 1873-4529; 1873-4529
• DOI: 10.1016/j.jclinane.2011.11.007

To determine if practicing anesthesiologists recommend preoperative evaluations consistent with the 2007 ACC/AHA guidelines on perioperative care. Survey instrument. Academic medical center. ASA membership. In this Web-based survey, participants were presented with 6 clinical scenarios characterized by surgical procedure and the patient's clinical condition (ie, clinical risk factors and functional capacity). Scenarios and possible recommendations were presented randomly. Participants were asked to select the recommendation they considered to be most consistent with the Guidelines. The percentage of participants selecting the recommendation most consistent with the 2007 Guidelines was recorded. Of the 22,504 actively practicing members of the ASA who were sent a survey, 1,595 actively practicing self-selected anesthesiologists responded. For one of 6 scenarios, patients with an active cardiac condition, the upper 95% confidence bound for the percent selecting a recommendation consistent with the Guidelines was 82%. For the remaining 5 scenarios, the upper 95% confidence bound for the percent of anesthesiologists with an appropriate recommendation did not exceed 40%. With the exception of the scenario describing a patient with an active cardiac condition, respondents were more likely to provide recommendations consistent with the Guidelines if they had been in practice less than 5 years or worked in a teaching environment. When evaluating simulated patients, practicing anesthesiologists who are ASA members did not recommend preoperative evaluations that were consistent with the 2007 ACC/AHA Guidelines.