title: The impact of pre-operative focused transthoracic echocardiography in emergency non-cardiac surgery patients with known or risk of cardiac disease.
abstract: This prospective observational study investigated the effect of focused transthoracic echocardiography in 99 patients who had suspected cardiac disease or were ≥ 65 years old, and were scheduled for emergency non-cardiac surgery. The treating anaesthetist completed a diagnosis and management plan before and after transthoracic echocardiography, which was performed by an independent operator. Clinical examination rated cardiac disease present in 75%; the remainder were asymptomatic. The cardiac diagnosis was changed in 67% and the management plan in 44% of patients after echocardiography. Cardiac disease was identified by echocardiography in 64% of patients, which led to a step-up of treatment in 36% (4% delay for cardiology referral, 2% altered surgery, 4% intensive care and 26% intra-operative haemodynamic management changes). Absence of cardiac disease in 36% resulted in a step-down of treatment in 8% (no referral 3%, intensive care 1% or haemodynamic treatment 4%). Pre-operative focused transthoracic echocardiography in patients admitted for emergency surgery and with known cardiac disease or suspected to be at risk of cardiac disease frequently alters diagnosis and management.
authors.affiliation: Department of Anaesthesia, The Royal Melbourne Hospital, Melbourne, Vic., Australia. dcanty@unimelb.edu.au
authors.forename: D J
authors.initials: DJ
authors.lastname: Canty
authors.forename: C F
authors.initials: CF
authors.lastname: Royse
authors.forename: D
authors.initials: D
authors.lastname: Kilpatrick
authors.forename: D L
authors.initials: DL
authors.lastname: Williams
authors.forename: A G
authors.initials: AG
authors.lastname: Royse
mesh_terms: D000368:Aged; D000075202:Contraindications; D004630:Emergencies; D005260:Female; D006331:Heart Diseases / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D010347:Patient Care Planning; D010865:Pilot Projects; D011300:Preoperative Care / Q000379:methods*; D011446:Prospective Studies; D012017:Referral and Consultation / Q000706:statistics & numerical data; D018570:Risk Assessment / Q000379:methods; D013514:Surgical Procedures, Operative; D014463:Ultrasonography