Circulation Journal
Online ISSN : 1347-4820
Print ISSN : 1346-9843
ISSN-L : 1346-9843
Imaging
Association of Echocardiography Before Major Elective Non-Cardiac Surgery With Improved Postoperative Outcomes ― Possible Implications for Patient Care ―
Kenya KusunoseYuta ToriiHirotsugu YamadaSusumu NishioYukina HirataYoshihito SaijoTakayuki IseKoji YamaguchiDaiju FukudaShusuke YagiTakeshi SoekiTetsuzo WakatsukiMasataka Sata
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Supplementary material

2019 Volume 83 Issue 12 Pages 2512-2519

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Abstract

Background:Whether preoperative echocardiography improves postoperative outcomes is not well established, so we examined the value of echocardiographic assessment on the onset of postoperative heart failure (HF), and determining which patients benefitted most from undergoing echocardiography prior to major elective non-cardiac surgery.

Methods and Results:We identified all patients aged 50 years and older who had major elective non-cardiac surgery, and excluded patients with previously identified severe cardiovascular disease. The primary endpoint was the onset of HF during hospitalization. A total of 806 patients were included in the analysis. During hospitalization, 49 patients (6%) reached the primary endpoint. Within the matched cohort, preoperative echocardiography was associated with a statistically significant decrease in postoperative HF (hazard ratio: 0.46, P=0.01). In subgroup analyses, age, sex, body surface area, hypertension, diabetes mellitus, prior HF, surgical type, chronic kidney disease, pulmonary disease, and malignancy influenced the association of echocardiography with postoperative HF.

Conclusions:The use of echocardiography in elderly patients with certain risk factors was associated with improved postoperative outcomes. The basis for this finding remains to be determined; particularly whether echocardiography is simply a marker of a population with better outcomes or whether it leads to better management that improves outcomes.

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© 2019 THE JAPANESE CIRCULATION SOCIETY
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