Preoperative cardiac POCUS in high-risk non-cardiac surgery: A prospective study on anesthetic planning and outcomes

TL;DR

This study shows that using cardiac POCUS before high-risk non-cardiac surgery helps improve anesthetic planning and patient outcomes.

Contribution

The study demonstrates how preoperative cardiac POCUS can lead to better anesthetic decisions and improved stability during surgery.

Findings

31.7% of patients had previously undiagnosed cardiac issues detected by POCUS.

24.2% of patients had their anesthesia plans modified based on POCUS findings.

Modified plans were linked to fewer hypotensive episodes and fewer ICU admissions.

Abstract

The role of preoperative cardiac point-of-care ultrasound (POCUS) in modifying anesthetic management and influencing perioperative
outcomes in high-risk non-cardiac surgery patients is of interest. A total of 120 adults with Revised Cardiac Risk Index ≥2 or
significant cardiac comorbidity underwent standardized preoperative focused transthoracic echocardiography. Clinically significant
previously undiagnosed cardiac findings were detected in 31.7% of patients, leading to anesthesia plan modifications in 24.2%, including
escalation to invasive monitoring, anesthesia technique changes and preoperative cardiology consultation. Patients whose plans were
modified experienced fewer intraoperative hypotensive episodes and reduced unplanned intensive care admissions compared with those
without plan changes. Thus, we show the integration of preoperative cardiac POCUS into perioperative assessment pathways for high-risk
surgical patients to optimize management and improve hemodynamic stability.