Preoperative Echocardiography Does Not Appear to Improve Survival in Patients having Elective Noncardiac Surgery
DynaMed Weekly Update - Volume 6, Issue 32
An echocardiogram is often performed prior to noncardiac surgery to identify patients at risk of cardiac complications even though the American College of Cardiology recommends against routine perioperative evaluation of left ventricular function in such patients ( Circulation. 2007 Oct 23;116). A recent retrospective cohort study suggests that preoperative echocardiography may provide little benefit. From a cohort of 264,000 patients aged 40 years old having elective intermediate or high-risk noncardiac surgery, 35,498 patients who had a preoperative resting echocardiogram were matched to an equal number with no echocardiogram. Matching was based on multiple factors including demographics, comorbidities, type of surgery planned, and hospital characteristics.
The echocardiography group had significantly increased mortality at 30 days (2% vs. 1.7%, p < 0.05, NNH 423) and at 1 year (7.4% vs. 6.9%, p < 0.05, NNH 222) (level 2 [mid-level] evidence). Echocardiography was also associated with increased hospital stay (mean difference 0.31 days). There were no significant differences in surgical site infections, a marker for perioperative risk that is unaffected by echocardiography (13.2% vs. 12.9%). A subgroup analysis showed no significant difference in 1-year mortality in patients who had a preoperative stress test (BMJ 2011 Jun 30;342:d3695).
For more information, see the Perioperative cardiac management for noncardiac surgery topic in DynaMed.