Thread by @mcisaac_d

Does a #preop #medicine consult lead to better outcomes?
Probably not in most cases
New in @JAMAInternalMed from @OttawaHospital @OttAnesthesia @aims_periop @OttawaIM @ICESOntario

bit.ly/3LZ3Vf4

1/
Among those who had a consult, baseline risk was higher (not surprising)

But, even with clustered adjustment and PS matching…

No signs of benefit:
-OR 1.19 (1.11-1.29) mortality
-LoS, costs and adverse events also significantly⬆️ with consult
-Consistent in sens analyses

2/
Testing ⬆️
Interventions ⬆️
New B-blocker Rx ⬆️

Were consult pts just less healthy and our data couldn’t adequately adjust? Maybe…

But rates of cancer screening no different btw groups

3/
Also, pt factors aren’t what drove variation is use of consults.

Regional variation was HUGE (3-fold difference between lowest and highest consults regions)

And no higher risk subgroups showed any benefit (higher risk of death in all subgroups)

4/
But, despite using validated exposure and outcome measures and robust control for confounders…this is not an RCT

Findings are consistent with similar studies except for one set:

-Preoperative geriatric assessment

5/
In Ontario (observational)

bit.ly/42GSf6B

And in RCTs

bit.ly/3JOCwd5

bit.ly/3TMZhmd

Geriatric assessment and care reduce AEs and improve cognitive/functional recovery

So maybe we can turn all of this resource toward the evidence?

And a huge congrats to wrap this up to Dr Weiwei Beckerleg who led this study as part of her MPH @HarvardChanSPH