BACKGROUND Preoperative resting echocardiography is often performed before noncardiac surgery, but indications for preoperative resting echocardiography are limited. This study aimed to investigate appropriateness of preoperative resting echocardiography using the Appropriate Use Criteria for Echocardiography, which encompass indications from the guidelines on perioperative cardiovascular evaluation and management and nonperioperative indications independent of the perioperative period. The authors hypothesized that patients are frequently tested without an appropriate indication. METHODS Records of patients in the Truven Health MarketScan Commercial and Medicare Supplemental Databases who underwent a major abdominal surgery from 2005 to 2017 were included. These databases contain de-identified records of health services for more than 250 million patients with primary or Medicare supplemental health insurance coverage through employer-based fee-for-service, point-of-service, or capitated plans. Patients were classified based on the presence of an outpatient claim for resting transthoracic echocardiography within 60 days of surgery. Appropriateness was determined via International Classification of Diseases, Ninth Revision-Clinical Modification, and International Classification of Diseases, Tenth Revision-Clinical Modification principal and secondary diagnosis codes associated with the claims, and classified as "appropriate," "rarely appropriate," or "unclassifiable" using the Appropriate Use Criteria for Echocardiography. RESULTS Among 230,535 patients in the authors' cohort, preoperative resting transthoracic echocardiography was performed in 6.0% (13,936) of patients. There were 12,638 (91%) studies classifiable by the Appropriate Use Criteria for Echocardiography, and 1,298 (9%) were unable to be classified. Among the classifiable studies, 8,959 (71%) were deemed "appropriate," while 3,679 (29%) were deemed "rarely appropriate." Surveillance of chronic ischemic heart disease and uncomplicated hypertension accounted for 43% (1,588 of 3,679) of "rarely appropriate" echocardiograms. CONCLUSIONS More than one in four preoperative resting echocardiograms were considered "rarely appropriate" according to the Appropriate Use Criteria for Echocardiography. A narrow set of patient characteristics accounts for a large proportion of "rarely appropriate" preoperative resting echocardiograms. EDITOR’S PERSPECTIVE

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评估腹部大手术前适当使用术前超声心动图：一项回顾性队列研究。

背景 术前静息超声心动图通常在非心脏手术之前进行，但术前静息超声心动图的适应症有限。本研究旨在使用超声心动图的适当使用标准调查术前静息超声心动图的适用性，其中包括围手术期心血管评估和管理指南中的适应症以及独立于围手术期的非围手术期适应症。作者假设患者经常在没有适当适应症的情况下接受检测。方法 纳入 Truven Health MarketScan Commercial 和 Medicare 补充数据库中 2005 年至 2017 年接受腹部大手术的患者记录。这些数据库包含超过 2.5 亿名通过基于雇主的按服务收费、服务点或按人头计费计划获得初级或 Medicare 补充健康保险的患者的去识别化医疗服务记录。根据手术后 60 天内是否有门诊要求静息经胸超声心动图对患者进行分类。适当性通过与权利要求相关的国际疾病分类、第九次修订-临床修改和国际疾病分类、第十次修订-临床修改主要和次要诊断代码确定，并分类为“适当”、“很少适当”或“不可分类”使用超声心动图的适当使用标准。结果 在 230 个中，在作者队列中的 535 名患者中，6.0% (13,936) 的患者进行了术前静息经胸超声心动图检查。有 12,638 (91%) 项研究可按超声心动图的适当使用标准分类，1,298 (9%) 项研究无法分类。在可分类的研究中，8,959 项（71%）被认为“合适”，而 3,679 项（29%）被认为“很少合适”。慢性缺血性心脏病和单纯性高血压的监测占“很少合适”超声心动图的 43%（3,679 例中的 1,588 例）。结论 根据超声心动图的适当使用标准，超过四分之一的术前静息超声心动图被认为是“很少合适的”。一组狭窄的患者特征占“