Is preop cards eval dangerous?

A provocative article from the prolific Toronto group (running neck-and-neck with Rotterdam) that suggests that preop internist/cardiologist consultation before intermediate-high risk surgery leads to more testing. more new beta blockade and statin use, but higher mortality and longer hospital LOS!


  • very large, validated databases
  • sophisticated propensity analysis
  • unmeasured variable that could account for differences would have to be fairly common and have large effects.


  • Retrospective study can only show associations, not prove causation
  • The patients that couldn’t matched for propensity analysis were much sicker

From the manuscript’s abstract:

“Conclusions: Medical consultation before major electivenoncardiac surgery is associated with increased mortalityand hospital stay, as well as increases in preoperativepharmacologic interventions and testing. Thesefindings highlight the need to better understand mechanismsby which consultation influences outcomes andto identify efficacious interventions to decrease perioperative risk. ”
Arch Intern Med. 2010;170(15):1365-1374

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