. Author manuscript; available in PMC: 2024 Nov 1.

Published in final edited form as: J Hosp Med. 2023 Sep 20;18(11):1021–1033. doi: 10.1002/jhm.13206

Table 1 –

Study Characteristics

Study, year	Study design^* (intervention if applicable)	Data source	Setting	Inclusion (Exclusion) Criteria	Type of surgery	Type of preop cardiac testing	Risk of Bias
Adair 2017²²	Cross-sectional	Registry derived from EMR	AMC, 5/2009-11/2012	>55 years old	Hip fracture surgery	Echo	Moderate
Aviki 2022⁴⁵	Pre-post	EMR	AMC 7/2014-12/2015 (pre); 7/2016-12/2017 (post)	Adults	Ambulatory endometrial surgery	EKG	High
Chan 2018³²	Cross-sectional	Collaborative registry	Southern California, 9/2012-5/2016	No history of CAD	Various vascular surgeries	Stress test	Moderate
Charlesworth 2016³⁶	Cross-sectional	Medicaid claims and All-Payer, All-Claims database	Oregon, 1/2013-12/2013	Between 18 to 64 years of age enrolled in either Medicaid or commercial insurance (Excl – pregnant or dual-eligible patients)	Low or intermediate risk non-cardiothoracic surgery	Echo, stress test	Moderate
Clark 2019³⁷	Cross-sectional	Interviews with thoracic surgeons	Online, 2018-2019	Participation in the Society of Thoracic Surgeons	Lung resections	Echo, stress test	High
Colla 2018²³	Retrospective cohort	100 % Medicare claims and commercial claims from HCCI	National data from 2009 through 2011	Enrollment in Medicare Part A and Part B (for Medicare beneficiaries)	Low-risk, noncardiac surgery	EKG, echo, stress tests, cardiac CT, MRI, and PET	Moderate
Ellenbogen 2019³⁸	Cross-sectional	State Inpatient Databases from Maryland, New Jersey, and Washington	Acute care hospitals, 2011-2015	Primary ICD procedure code for hip fracture repair (Excl – interhospital transfers)	Hip fracture repair	Echo, stress test, and cardiac catheterization	Moderate
Esper 2022⁴⁶	Pre-post	Geriatric trauma database	Orthopedic specialty hospital 9/2015-6/2021 (Intervention-5/ 2019)	Adults	Hip fracture repair	Echo	Moderate
Ganguli 2019²⁴	Retrospective cohort	FFS Medicare claims (20% sample)	Medicare FFS patients, (4/2013-9/2015)	Aged 66 or older and continuously enrolled in FFS Medicare during study period (Excl: diagnosis of cardiac disease in the last year)	Cataract surgery	EKG (associated with cascades of further testing)	Low
Gertz 2016⁴⁷	Pre-post	EMR	AMC, 9/2010-2/2012 (washout period of 2/2011-9/2011)	Hospitalized adults receiving a stress test	Low-risk surgery	Stress test	Moderate
Hasan 2022⁴¹	Retrospective cohort	New York Statewide Planning and Research Cooperative System	3/2016-6/2017	Adults with a preoperative outpatient visit within two months of surgery	Total hip or knee replacement	EKG	Moderate
Kerr 2015²⁵	Retrospective cohort	VA Corporate Data Warehouse, Medicare FFS claims (5% sample)	2/2009-12/2009	Ages 65 years or older	Cataract surgery, knee or shoulder arthroscopy	Stress test	Moderate
King 2023³¹	Cross-sectional	EMR	AMC, 1/2015-12/ 2019	Adults (Excl – receiving cardiac testing for known or suspected angina or ischemic equivalent)	Laparoscopic bariatric surgery	EKG, echo, stress test, cardiac catheterization	Moderate
Langell 2016⁴⁸	Pre-post	EMR	AMC, 2-3/2012 (pre), 2-3/2013 (post)	Outpatients	Elective non-cardiac surgery	EKG	High
Mafi 2019⁴⁴	Non-randomized controlled trial	EMR	2 safety net AMCs, 4/2015-4/2016; control was another AMC	Adults	Cataract surgery	EKG	Moderate
Marcantonio 2013²⁶	Retrospective cohort	Internal billing database	AMC, 1/2004-2/2011	Adults 65 and older	Hip fracture surgery	Echo	High
Muthappan 2014³⁴	Retrospective cohort	Data collection forms and registry	14 hospitals in Michigan	Adults (Excl – recent MI with intervention, cardiac arrest, or medications suggesting high cardiac complexity)	High risk, non-cardiac surgery	PCI	Low
Nelson 2019⁴⁹	Pre-post	Perioperative data warehouse	AMC, 1/2010-10/2015	Adults visiting the preoperative evaluation clinic	Any surgery	EKG	Low
Pappas 2021³⁵	Cross-sectional	EMR	AMC, 2008-2018	Adults receiving preoperative cardiac testing within 30 days of preoperative clinic visit	All except cardiac or ophthalmologic surgery	Stress test	Low
Peterson 2018³⁹	Cross-sectional	EMR	AMC, 1/2012-12/2014	Adults	All except cardiac or transplant	Stress test	Moderate
Pickering 2022³⁰	Retrospective cohort	VA Corporate Data Warehouse	Veterans Hospital Administration, 10/2016-9/2018	Continuously enrolled veterans	Low or intermediate risk non-cardiothoracic surgery	EKG (associated with cascades of cardiac and non-cardiac testing)	Low
Ponukumati 2022³³	Retrospective cohort	Vascular Quality Initiative Registry	Vascular Quality Initiative Centers, 2015-2019	Adults (Excl - urgent or emergent AAA repair, unknown indication for AAA repair)	AAA repair	Stress test	Moderate
Riggs 2018⁴²	Retrospective cohort	MarketScan Commercial Claims Database	All states, 2010-2013	Commercially insured patients, ages 18-64; at least one outpatient visit with a PCP one month to one year before surgery	Elective general, vascular, orthopedic, urologic, and gynecologic surgeries	EKG, echo, and stress test	Low
Rubin 2021⁴⁰	Cross-sectional	MarketScan Research Databases, including Medicare supplemental coverage	All states, 2004-2017	Adults	Elective total hip or total knee arthroplasty	Stress test	Low
Sheffield 2013²⁷	Cross-sectional	Medicare claims (5% sample)	All states, 1996-2008	Adults, 66 and over	Elective non-cardiac, non-vascular	Stress test	Low
Sigmund 2015⁴³	Retrospective cohort	National ambulatory and national hospital ambulatory medical care surveys	All states, 1997-2010	Adults with a preoperative visit or a general medical visit and an associated surgery	Any surgery	EKG, stress test	Low
Sinvani 2020²⁸	Cross-sectional	EMR	3 tertiary care and 4 community hospitals in a large integrated health system, 4/2014-12/2015	Adults, 65 and older	Hip fracture repair	Echo, stress test	High
Valle 2018²⁹	Retrospective cohort	VA Clinic Assessment Reporting and Tracking Program, Corporate Warehouse, and National Patient Care Database	131 VA facilities, 2004-2011	Adults who underwent surgery within 2 years of a PCI	Non-cardiac, non-emergent surgery	Stress test	Moderate

^{* -}

In studies with multiple outcomes (that led to ambiguity with respect to retrospective cohort versus cross-sectional study), we focused on the primary outcome to determine the study type.

Abbreviations:

AAA – Abdominal Aortic Aneurysm

AMC – Academic Medical Center

CAD – Coronary Artery Disease

CT – Computed Tomography

EKG - Electrocardiogram

EMR – Electronic Medical Record

FFS – Fee-for-service

HCCI – Health Care Cost Institute

MI – Myocardial infarction

MRI – Magnetic Resonance Imaging

PCP – Primary Care Provider

PCI – Percutaneous Coronary Intervention

PET – Positron Emission Tomography

VA – Veterans Affairs