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A Questionable Return on Investment: Assessing The Cost of Preoperative Cardiac Testing

Nathan, Naveen MD

doi: 10.1213/ANE.0000000000003996
Infographics: Infographic

Northwestern University Feinberg School of Medicine (

Published ahead of print 20 November 2018.

The Infographic is composed by Naveen Nathan, MD, Northwestern University Feinberg School of Medicine ( Illustration by Naveen Nathan, MD.

The author declares no conflicts of interest.

Several widely used cardiac risk profile tools have been in use to better manage patients at risk for perioperative cardiovascular complications. To date, however, little is known about whether the efforts employed by way of these tools lead to a significant change in intraoperative management or definitive outcome differences. In this issue, Pappas et al pursued an estimation of the direct cost of preoperative cardiovascular risk stratification and attendant testing in a cohort of over 300,000 noncardiac surgical patients. This infographic summarizes their key findings which show the importance of careful assessment of functional status as well as the significant discordance between 2 of the most popular risk stratification tools: RCRI and MICA. The reader is encouraged to explore this article as well as its corresponding editorial for further depth of understanding.

ACC/AHA indicates American College of Cardiology/American Heart Association; MICA, Myocardial Infarction or Cardiac Arrest; RCRI, Revised Cardiac Risk Index.

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1. Pappas MA, Sessler DI, Rothberg MB. Anticipated rates and costs of guideline-concordant preoperative stress testing. Anesth Analg. 2019;128:241–246.
2. Fleisher LA, Beckman JA, Wijeysundera DN. Does following Perioperative Cardiovascular Evaluation Guidelines increase perioperative costs? Anesth Analg. 2019;128:202203.
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