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Pre‐operative transthoracic echocardiography in ambulatory surgery—A cross‐sectional study
Author(s) -
Stenberg Ylva,
Lindelöf Linnea,
Hultin Magnus,
Myrberg Tomi
Publication year - 2020
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/aas.13620
Subject(s) - medicine , asymptomatic , perioperative , hypovolemia , ambulatory , cardiology , ejection fraction , heart failure , valvular heart disease , volume overload , prospective cohort study , surgery
Background Cardiac disease and aberrations in central volume status are risk factors for perioperative complications, and should be identified prior to surgery. This study investigated the benefit of transthoracic echocardiography (TTE) for pre‐operative identification of cardiac disease and hypovolemia in ambulatory surgery. Methods Ninety‐six patients, with a mean age of 63.5 ± 12.2 years and body mass index of 27.0 ± 4.3 kg/m 2 , scheduled for ambulatory surgery (breast, thyroid, and minor gastrointestinal), were consecutively enrolled in this prospective observational study. Pre‐operative comprehensive TTE was performed in order to assess heart failure (HF), asymptomatic left ventricular dysfunction, valvular disease, and aberrations in central volume status. Results Pre‐operative TTE identified a total of 28 cases of HF, 13 cases of HF with reduced or moderately reduced, ejection fraction (EF), and 15 cases of HF with preserved EF. Furthermore, 46 cases of asymptomatic left ventricular (LV) dysfunction were identified. 44/96 patients were hypovolemic, 16 of whom in severe hypovolemia. Seven cases of previously unknown obstructive valvular or myocardial disease and six cases of right ventricular systolic dysfunction were identified. A total of 24% (23/96) were classified as potential critical hemodynamic findings. The number needed (NNT) to treat for pre‐operative TTE in order to find one critical finding was 4.2. Conclusion In this ambulatory surgical cohort, a high prevalence of pre‐operative LV dysfunction and aberrations in volume status was observed. The results demonstrate that pre‐operative TTE contributed valuable hemodynamic information. The standard pre‐operative assessment for this cohort might need to be revised.