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Study: Presurgery Echocardiogram Is No Help

August 23, 2011
Written by: , Filed in: Cardiac Imaging
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Judging from the results of a new Canadian study, ordering an echocardiogram before major noncardiac surgery does more harm than good.

Specifically, the study found no evidence that patients who underwent a presurgery echocardiogram had improved survival rates one year after surgery. Some patients—those who had two or fewer risk factors for postoperative cardiac complications and who had not undergone cardiac stress testing—actually had a greater risk of dying within a year after surgery. Risk factors included diabetes, kidney disease, heart disease, and other such conditions.

Duminda Wijeysundera, MD, lead author of the study, summed up thus:

Given that echocardiography may actually cause harm, physicians should reconsider its role for patients undergoing elective surgery.

Dr. Wijeysundera was quoted in a news release from St. Michael’s Hospital in Toronto. He is a research scientist in the Keenan Research Centre of the Li Ka Shing Knowledge Institute of St. Michael’s and an anesthesiologist at Toronto General Hospital.

Canadian and U.S. researchers carried out the study, published earlier this summer in the British Medical Journal.

The study examined records of 264,823 Ontario residents who had undergone one of 14 medium- to high-risk major noncardiac surgery procedures from 1999 through 2008. Of the subjects, 15 percent had echocardiography before surgery.

Dr. Wijeysundera and his colleagues had previously shown that patients with at least one risk factor for postoperative cardiac complications had better survival after surgery if they had undergone preoperative stress testing. However, during the study period, Toronto doctors were 50 percent more likely to order an echocardiogram (the most commonly ordered preoperative cardiac test) than stress testing.

The researchers postulated several possible reasons that a presurgery echocardiogram might be unhelpful and, in some cases, hurtful. For example, because echocardiograms do not do well at distinguishing between high-risk and low-risk patients, some physicians may have been reassured that some patients who actually were high-risk could safely undergo surgery without additional specialized care.

Regardless, here is the bottom line, as summed up by Dr. Wijeysundera:

If echocardiography results in patients having a better chance of surviving after major surgery, its increased use is justified. If it does not, the relatively common use of echocardiography represents an unnecessary health care cost that may also unnecessarily delay scheduled surgeries.

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