A SURVEY ON THE INTENDED PURPOSES AND PERCEIVED UTILITY OF PREOPERATIVE CARDIOLOGY CONSULTATIONS

Cardiology consultations are often requested by surgeons and anesthesi ologists for patients with cardiovascular disease. There can be confus ion, however, regarding both the reasons for a consultation and their effect on patient management. This study was designed to determine the attitudes of physicians toward preoperative cardiology consultations and to assess the effect of such consultations on perioperative manage ment. A multiple-choice survey regarding the purposes and utility of c ardiology consultations was sent to randomly selected New York metropo litan area anesthesiologists, surgeons, and cardiologists. In addition , the charts of 55 consecutive patients aged >50 yr who received preop erative cardiology consultations were examined to determine the stated purpose of the consult, recommendations made, and concordance by surg eons and anesthesiologists with cardiologists' recommendations. Of the 400 surveys sent to each specialty, 192 were returned from anesthesio logists, 113 were returned from surgeons, and 129 were returned from c ardiologists. There was substantial disagreement on the importance and purposes of a cardiology consult: intraoperative monitoring, ''cleari ng the patient for surgery,'' and advising as to the safest type of an esthesia were regarded as important by most cardiologists and surgeons but as unimportant by anesthesiologists tall P < 0.05). Most surgeons (80.2%) felt obligated to follow a cardiologist's recommendations, wh ereas few anesthesiologists (16.6%) felt so obligated (P < 0.05). The most commonly stated purpose of the 55 cardiology consultations examin ed was ''preoperative evaluation.'' Only 5 of these (9%) were obtained for patients in whom there was a new finding. Of the cardiology consu ltations, 40% contained no recommendations other than ''proceed with c ase,'' ''cleared for surgery,'' or ''continue current medications.'' R ecommendations regarding intraoperative monitoring or cardiac medicati ons were largely ignored. Implications: We conclude that there seems t o be considerable disagreement among anesthesiologists, cardiologists, and surgeons as to the purposes and utility of cardiology consultatio ns. A review of 55 consecutive cardiology consultations suggests that most of them give little advice that truly affects management.