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Association of echocardiography before major elective non-cardiac surgery with postoperative survival and length of hospital stay: population based cohort study
Objective To determine the association of resting echocardiography before elective intermediate to high risk non-cardiac surgery with survival and length of hospital stay. Design Population based retrospective cohort study. Setting Acute care hospitals in Ontario, Canada, between 1 April 1999 and 31...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group Ltd.
2011
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3127454/ https://www.ncbi.nlm.nih.gov/pubmed/21724560 http://dx.doi.org/10.1136/bmj.d3695 |
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author | Wijeysundera, Duminda N Beattie, W Scott Karkouti, Keyvan Neuman, Mark D Austin, Peter C Laupacis, Andreas |
author_facet | Wijeysundera, Duminda N Beattie, W Scott Karkouti, Keyvan Neuman, Mark D Austin, Peter C Laupacis, Andreas |
author_sort | Wijeysundera, Duminda N |
collection | PubMed |
description | Objective To determine the association of resting echocardiography before elective intermediate to high risk non-cardiac surgery with survival and length of hospital stay. Design Population based retrospective cohort study. Setting Acute care hospitals in Ontario, Canada, between 1 April 1999 and 31 March 2008. Participants Patients aged over 40 years who had elective intermediate to high risk non-cardiac surgery. Intervention Resting echocardiography within 6 months before surgery. Main outcome measures Postoperative survival (30 days and 1 year) and length of hospital stay; postoperative surgical site infection as an outcome for which no association with echocardiography would be expected. Results Of the 264 823 patients in the entire cohort, 15.1% (n=40 084) had echocardiography. After use of propensity score methods to assemble a matched cohort (n=70 996) that reduced differences between patients who had or had not had echocardiography, echocardiography was associated with increases in 30 day mortality (relative risk 1.14, 95% confidence interval 1.02 to 1.27), 1 year mortality (1.07, 1.01 to 1.12), and length of hospital stay but no difference in surgical site infections (1.03, 0.98 to 1.06). The association with mortality was influenced (P=0.02) by whether patients had had stress testing or had risk factors for cardiac complications. No association existed between echocardiography and mortality among patients who had stress testing (relative risk 1.01, 0.92 to 1.11) or among patients at high risk who had not had stress testing (1.00, 0.87 to 1.13). However, echocardiography was associated with mortality in patients at low risk (relative risk 1.44, 1.14 to 1.82) and intermediate risk (1.10, 1.02 to 1.18) who had not had stress testing. Conclusions Preoperative echocardiography was not associated with improved survival or shorter hospital stay after major non-cardiac surgery. These findings highlight the need for further research to guide better use of this common preoperative test. |
format | Online Article Text |
id | pubmed-3127454 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2011 |
publisher | BMJ Publishing Group Ltd. |
record_format | MEDLINE/PubMed |
spelling | pubmed-31274542011-07-19 Association of echocardiography before major elective non-cardiac surgery with postoperative survival and length of hospital stay: population based cohort study Wijeysundera, Duminda N Beattie, W Scott Karkouti, Keyvan Neuman, Mark D Austin, Peter C Laupacis, Andreas BMJ Research Objective To determine the association of resting echocardiography before elective intermediate to high risk non-cardiac surgery with survival and length of hospital stay. Design Population based retrospective cohort study. Setting Acute care hospitals in Ontario, Canada, between 1 April 1999 and 31 March 2008. Participants Patients aged over 40 years who had elective intermediate to high risk non-cardiac surgery. Intervention Resting echocardiography within 6 months before surgery. Main outcome measures Postoperative survival (30 days and 1 year) and length of hospital stay; postoperative surgical site infection as an outcome for which no association with echocardiography would be expected. Results Of the 264 823 patients in the entire cohort, 15.1% (n=40 084) had echocardiography. After use of propensity score methods to assemble a matched cohort (n=70 996) that reduced differences between patients who had or had not had echocardiography, echocardiography was associated with increases in 30 day mortality (relative risk 1.14, 95% confidence interval 1.02 to 1.27), 1 year mortality (1.07, 1.01 to 1.12), and length of hospital stay but no difference in surgical site infections (1.03, 0.98 to 1.06). The association with mortality was influenced (P=0.02) by whether patients had had stress testing or had risk factors for cardiac complications. No association existed between echocardiography and mortality among patients who had stress testing (relative risk 1.01, 0.92 to 1.11) or among patients at high risk who had not had stress testing (1.00, 0.87 to 1.13). However, echocardiography was associated with mortality in patients at low risk (relative risk 1.44, 1.14 to 1.82) and intermediate risk (1.10, 1.02 to 1.18) who had not had stress testing. Conclusions Preoperative echocardiography was not associated with improved survival or shorter hospital stay after major non-cardiac surgery. These findings highlight the need for further research to guide better use of this common preoperative test. BMJ Publishing Group Ltd. 2011-06-30 /pmc/articles/PMC3127454/ /pubmed/21724560 http://dx.doi.org/10.1136/bmj.d3695 Text en © Wijeysundera et al 2011 This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode. |
spellingShingle | Research Wijeysundera, Duminda N Beattie, W Scott Karkouti, Keyvan Neuman, Mark D Austin, Peter C Laupacis, Andreas Association of echocardiography before major elective non-cardiac surgery with postoperative survival and length of hospital stay: population based cohort study |
title | Association of echocardiography before major elective non-cardiac surgery with postoperative survival and length of hospital stay: population based cohort study |
title_full | Association of echocardiography before major elective non-cardiac surgery with postoperative survival and length of hospital stay: population based cohort study |
title_fullStr | Association of echocardiography before major elective non-cardiac surgery with postoperative survival and length of hospital stay: population based cohort study |
title_full_unstemmed | Association of echocardiography before major elective non-cardiac surgery with postoperative survival and length of hospital stay: population based cohort study |
title_short | Association of echocardiography before major elective non-cardiac surgery with postoperative survival and length of hospital stay: population based cohort study |
title_sort | association of echocardiography before major elective non-cardiac surgery with postoperative survival and length of hospital stay: population based cohort study |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3127454/ https://www.ncbi.nlm.nih.gov/pubmed/21724560 http://dx.doi.org/10.1136/bmj.d3695 |
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