Table 1 Characteristics of surgical patients in the Veterans Affairs health system by whether or not they receive pre-operative echocardiographya
Patients with heart failure, valvular heart disease, recent myocardial infarction | Patients without heart failure, valvular heart disease, recent myocardial infarction | ||||||||
|---|---|---|---|---|---|---|---|---|---|
Echocardiogram in the 3 months prior to surgery | Yes (N = 1,732) | No (N = 4,307) | Yes (N = 2,646) | No (N = 17,956) | P-Value | ||||
Demographics | |||||||||
Age | |||||||||
Years, Median (25th percentile-75th percentile) | 67.0 | (61.0–75.0) | 67.0 | (60.0–75.0) | 65.0 | (60.0–73.0) | 64.0 | (59.0–72.0) | <0.001 |
<60 | 339 | (19.6) | 968 | (22.5) | 601 | (22.7) | 4,949 | (27.6) | <0.001 |
≥60 | 1,393 | (80.4) | 3,339 | (77.5) | 2,045 | (77.3) | 13,007 | (72.4) | |
Race | |||||||||
Black | 194 | (11.5) | 451 | (10.8) | 315 | (12.3) | 1,910 | (11.0) | 0.11 |
Other | 25 | (1.5) | 54 | (1.3) | 32 | (1.3) | 177 | (1.0) | |
White | 1,471 | (87.0) | 3,686 | (88.0) | 2,207 | (86.4) | 15,321 | (88.0) | |
Gender | |||||||||
Female | 27 | (1.6) | 94 | (2.2) | 40 | (1.5) | 401 | (2.2) | 0.04 |
Male | 1,705 | (98.4) | 4,213 | (97.8) | 2,606 | (98.5) | 17,555 | (97.8) | |
Health status | |||||||||
Echocardiogram in the 3 to 12 Months Prior to Surgery | |||||||||
No | 1,105 | (63.8) | 2,318 | (53.8) | 2,254 | (85.2) | 14,561 | (81.1) | <0.001 |
Yes | 627 | (36.2) | 1,989 | (46.2) | 392 | (14.8) | 3,395 | (18.9) | |
Myocardial infarction within 6 months | |||||||||
No | 997 | (57.6) | 2,465 | (57.2) | 2,646 | (100.0) | 17,956 | (100.0) | <0.001 |
Yes | 735 | (42.4) | 1,842 | (42.8) | 0 | (0.0) | 0 | (0.0) | |
Heart failure hospitalization within 6 months | |||||||||
No | 1,108 | (64.0) | 3,115 | (72.3) | 2,646 | (100.0) | 17,956 | (100.0) | <0.001 |
Yes | 624 | (36.0) | 1,192 | (27.7) | 0 | (0.0) | 0 | (0.0) | |
History of heart failure | |||||||||
No | 784 | (45.3) | 2,381 | (55.3) | 1,974 | (74.6) | 15,444 | (86.2) | <0.001 |
Yes | 948 | (54.7) | 1,924 | (44.7) | 672 | (25.4) | 2,472 | (13.8) | |
Valvular heart disease | |||||||||
No | 882 | (50.9) | 2,329 | (54.1) | 2,646 | (100.0) | 17,956 | (100.0) | <0.001 |
Yes | 850 | (49.1) | 1,978 | (45.9) | 0 | (0.0) | 0 | (0.0) | |
Coronary artery stents | |||||||||
None | 918 | (53.0) | 2,231 | (51.8) | 1,905 | (72.0) | 12,764 | (71.1) | <0.001 |
Bare metal stents | 433 | (25.0) | 1,222 | (28.4) | 382 | (14.4) | 2,563 | (14.3) | |
Drug-eluting stents | 371 | (21.4) | 830 | (19.3) | 350 | (13.2) | 2,563 | (14.3) | |
Both bare metal and drug-eluting stents | 10 | (0.6) | 24 | (0.6) | 9 | (0.3) | 66 | (0.4) | |
Diabetes | |||||||||
None | 1,031 | (59.5) | 2,830 | (65.7) | 1,723 | (65.1) | 12,360 | (68.8) | <0.001 |
Non-insulin dependent | 308 | (17.8) | 754 | (17.5) | 483 | (18.3) | 3,165 | (17.6) | |
Insulin dependent | 393 | (22.7) | 723 | (16.8) | 440 | (16.6) | 2,431 | (13.5) | |
Peripheral vascular disease | |||||||||
No | 1,063 | (61.4) | 2,854 | (66.3) | 1,760 | (66.5) | 13,772 | (76.7) | <0.001 |
Yes | 669 | (38.6) | 1,453 | (33.7) | 886 | (33.5) | 4,184 | (23.3) | |
Stroke | |||||||||
No | 1,681 | (97.1) | 4,230 | (98.3) | 2,544 | (96.2) | 17,673 | (98.6) | <0.001 |
Yes | 51 | (2.9) | 75 | (1.7) | 102 | (3.9) | 243 | (1.4) | |
Hypertension | |||||||||
No | 117 | (9.2) | 277 | (10.1) | 196 | (9.9) | 1,772 | (14.2) | <0.001 |
Yes | 1,154 | (90.8) | 2,458 | (89.9) | 1,784 | (90.1) | 10,749 | (85.9) | |
Coronary artery bypass grafting | |||||||||
No | 1,600 | (92.4) | 4,024 | (93.4) | 2,554 | (96.5) | 17,467 | (97.3) | <0.001 |
Yes | 132 | (7.6) | 283 | (6.6) | 92 | (3.5) | 489 | (2.7) | |
Chronic kidney disease | |||||||||
No | 1,268 | (73.2) | 3,514 | (81.6) | 2,229 | (84.2) | 16,083 | (89.6) | <0.001 |
Yes | 464 | (26.8) | 793 | (18.4) | 417 | (15.8) | 1,873 | (10.4) | |
Arrhythmia | |||||||||
No | 789 | (45.6) | 2,207 | (51.2) | 1,681 | (63.5) | 12,899 | (71.8) | <0.001 |
Yes | 943 | (54.5) | 2,100 | (48.8) | 965 | (36.5) | 5,057 | (28.2) | |
Pacemaker | |||||||||
No | 1,686 | (97.3) | 4,225 | (98.1) | 2,618 | (98.9) | 17,828 | (99.3) | <0.001 |
Yes | 46 | (2.7) | 82 | (1.9) | 28 | (1.1) | 128 | (0.7) | |
Cardioverter defibrillator | |||||||||
No | 1,697 | (98.0) | 4,235 | (98.3) | 2,629 | (99.4) | 17,870 | (99.5) | <0.001 |
Yes | 35 | (2.0) | 72 | (1.7) | 17 | (0.6) | 86 | (0.5) | |
Operative Characteristics | |||||||||
Inpatient/Outpatient, n (%) | |||||||||
Outpatient | 456 | (26.4) | 1,536 | (35.8) | 751 | (28.5) | 8,092 | (45.1) | <0.001 |
Inpatient | 1,273 | (73.6) | 2,761 | (64.3) | 1,886 | (71.5) | 9,837 | (54.9) | |
Work Relative Value Unit | |||||||||
Median (25th percentile-75th percentile) | 18.2 | (11.8–22.6) | 15.4 | (9.6–21.8) | 19.6 | (11.8–23.3) | 15.3 | (8.4–21.8) | <0.001 |
<10 | 762 | (44.0) | 1,887 | (43.8) | 1,124 | (42.5) | 6,821 | (38.0) | <0.001 |
10–20 | 372 | (21.5) | 1,177 | (27.3) | 514 | (19.4) | 5,847 | (32.6) | |
>20 | 597 | (34.5) | 1,243 | (28.9) | 1,008 | (38.1) | 5,288 | (29.5) | |
High Risk Surgery | |||||||||
No | 1,286 | (74.3) | 3,332 | (77.4) | 1,909 | (72.2) | 14,417 | (80.3) | <0.001 |
Yes | 446 | (25.8) | 975 | (22.6) | 737 | (27.9) | 3,539 | (19.7) | |
Procedure Type | |||||||||
Digestive | 402 | (23.2) | 1,141 | (26.5) | 593 | (22.4) | 4,959 | (27.6) | <0.001 |
Eye/Ear/Skin | 31 | (1.8) | 85 | (2.0) | 38 | (1.4) | 299 | (1.7) | |
Genital/Urinary | 206 | (11.9) | 607 | (14.1) | 285 | (10.8) | 2,616 | (14.6) | |
Musculoskeletal | 272 | (15.7) | 828 | (19.2) | 475 | (18.0) | 4,465 | (24.9) | |
Nervous | 34 | (2.0) | 119 | (2.8) | 88 | (3.3) | 709 | (4.0) | |
Other | 50 | (2.9) | 102 | (2.4) | 78 | (3.0) | 422 | (2.4) | |
Respiratory | 82 | (4.7) | 146 | (3.4) | 156 | (5.9) | 509 | (2.8) | |
Vascular | 655 | (37.8) | 1,279 | (29.7) | 933 | (35.3) | 3,977 | (22.2) | |
Time to Surgery Since Stent | |||||||||
Days, Median (25th percentile-75th percentile) | 132.0 | (63.0–370.0) | 184.0 | (104.5–433.0) | 347.0 | (92.0–515.0) | 406.0 | (251.0–552.0) | |
None | 100 | (5.8) | 130 | (3.0) | 79 | (3.0) | 173 | (1.0) | <0.001 |
<6 Weeks | 214 | (12.4) | 287 | (6.7) | 103 | (3.9) | 266 | (1.5) | <0.001 |
6 Weeks to 3 Months | 166 | (9.6) | 611 | (14.2) | 41 | (1.6) | 341 | (1.9) | |
3 to 6 Months | 123 | (7.1) | 389 | (9.0) | 169 | (6.4) | 1,405 | (7.8) | |
6 to 12 Months | 211 | (12.2) | 659 | (15.3) | 349 | (13.2) | 3,007 | (16.8) | |
>12 Months | 918 | (53.0) | 2,231 | (51.8) | 1,905 | (72.0) | 12,764 | (71.1) | |