Pre-operative transthoracic echocardiography in ambulatory surgery : a cross sectional study

BACKGROUND: Cardiac disease and aberrations in central volume statusare risk factors for perioperative complications,and should be identified prior to surgery. This study investigatedthe benefit of transthoracic echocardiography for preoperative identification of cardiac disease andhypovolemia 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/m2 , scheduled for ambulatorysurgery (breast, thyroid, minor gastrointestinal), were consecutively enrolled in this prospective observational study. Preoperative comprehensive transthoracic echocardiographywas performed in order to assess heart failure, asymptomatic left ventricular dysfunction, valvular disease and aberrations incentral volume status. RESULTS: Preoperative transthoracic echocardiography identified a total of 28 cases of heart failure; thirteen cases of heart failure with reduced, or moderately reduced, ejection fraction and fifteen cases of heart failure with preserved ejection fraction. Furthermore, forty-six cases of asymptomatic left ventricular dysfunction were identified. 44/96 patients were hypovolemic, 16 of whom in severe hypovolemia.Seven cases of previously unknown obstructive valvular or myocardial diseaseand 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 to treat for preoperative TTE in order to find one critical finding was 4.2. CONCLUSION: In this ambulatory surgical cohort, a high prevalence of preoperative LV dysfunction and aberrations in volume status was observed. The results demonstrate that preoperative TTE contributed valuable hemodynamic information. The standard preoperative assessment for this cohort might need to be revised