Evidence mapPaperPMID 37728150Full record

SynthesisJournal of hospital medicine2023

Patient, provider, and system-level factors associated with preoperative cardiac testing: A systematic review.

Michael I Ellenbogen, Aleksandra Drmanovic, Jodi B Segal, Shrey Kapoor, Phillip C Wagner

Open access · greenAbstract readSystematic Review
In one paragraph

Synthesis in Journal of hospital medicine, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
0.7field-weighted citation impact, top 27% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed, 3 citations in OpenAlex.

  1. Observational
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors at 1 institution in 1 country.

Michael I EllenbogenDepartment of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.ORCID 0000-0003-0701-8054
Aleksandra DrmanovicDepartment of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.ORCID 0009-0003-0302-4403
Jodi B SegalDepartment of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
Shrey KapoorDepartment of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
Phillip C WagnerDepartment of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
Johns Hopkins University · US

Funding

Towards Reduction of Harmful Overuse of Healthcare in Older AdultsK24AG049036 · NIA · JOHNS HOPKINS UNIVERSITY · PI JODI B. SEGAL · 2022 to 2022
$153k
AHRQ HHS K08 HS028673NIA NIH HHS K24 AG049036
6 · The paper itself

Abstract

backgroundOveruse 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.

objectiveTo conduct a systematic review to better delineate the patient, provider, and system-level factors associated with variation in preoperative cardiac testing.

methodsWe 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.

resultsTwenty-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.

conclusionsThere 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.

Indexed as

Health Care CostsAdultComorbidityHumans

Identifiers

PMID37728150
PMCPMC10877614
OpenAlexW4386878356

What Socratic holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.