Prediction of morbidity and mortality in middle and old aged surgical patients-comparison of standard scoring system and addition of echocardiography with hemodynamic indices
DOI:
https://doi.org/10.18203/2320-6012.ijrms20150787Keywords:
Standard scoring system, Preoperative trans thoracic echocardiography (TTE), Hemodynamic indicesAbstract
Background: A prospective study was carried out in our hospital to predict morbidity and mortality in middle and old aged surgical patients by adding echocardiography to standard scoring system with hemodynamic studies.
Methods: A total of 50 patients of either sex ranging from 40-70 years of ASA grade 1 & 2 scheduled for various types of noncardiac surgeries were enrolled for the study in our hospital. Patients were divided in two groups according to echocardiographic examinations. The patients with normal echocardiographic values were kept in control group and the patients with abnormal values were kept under study group. The patients in study group were further divided in three groups according to LVEF. Group1-LEVF≥60%, Group2-LVEF≥50-59%, Gr3≥40-49% Tab lorazepam was given to all the patients’ orally prior night of surgery. All the patients were induced with same type inducing agents according to body weight. All the patients were maintained on IPPV by anaesthesia machine with supplemental fentanyl, N2O, O2 and muscle relaxant. SPO2, electrocardiograph (ECG), Non-invasive/invasive blood pressure (BP), Spirometry, Capnography and temperature were monitored. At the end of the research project data’s were compiled systematically and were subjected to statistical analysis using odd’s ratio(OR),95% confidence interval (CI), z value and p value, two statistical software programme were used.
Results: Significant difference in the results seen between the three study groups (Gr1, Gr2, Gr3) for perioperative ischemic changes, CHF and arrhythmias.
Conclusions: In conclusion preoperative TTE before non-cardiac surgery can predict the risk of perioperative cardiac complications in known or suspected cases of cardiac disease patients.
References
Poldermans D, Fioretti PM, Forster T, Thomson IR, Boersma E, et al. Dobutamine stress echocardiography for assessment of perioperative cardiac risk in patients undergoing major vascular surgery, 1993.
Canty DJ, Royse CF, Kilpatric D, Bowmen L, Royse AG. The impact of focussed transthoracic echocardiography in the pre-operative clinic. Anaesthesia. 2012;67:618-25.
Rohde LE, Polanczyk CA, Goldman L, Cook EF, Lee RT, Lee TH. Usefulness of transthoracic echocardiography as a tool for risk stratification of patients undergoing major noncardiac surgery. Am J Cardiol. 2001;87:505-9.
Sharir T, Germano G, Kang X, et al. Prediction of myocardial infarction versus cardiac death by gated myocardial perfusion SPECT: risk stratification by the amount of stress induced ischemia and the poststress e, fraction. J Nucl Med, 2001.
Subramani S, Tewari A. Preoperative echocardiography: Evidence or experience based utilization in noncardiac surgery? J Anaesthesiol Clin Pharmacol. 2014;30(3):313-35.
Wijeysundera DN, Beattie WS, Karkouti K, Neuman MD, Austin PC, Laupacis A. Association of echocardiography before major elective non-cardiac surgery with post-operative survival and lenth of hospital stay: Population based cohort study. BMJ. 2011;342:d3695.
Halm EA, Browner WS, Tubau JF, Tateo IM, Mangano DT. Echocardiography for assessing cardiac risk in patients having non-cardiac surgery:Study of Perioperative Ischemia Resarch Group. Ann Intern Med. 1996;125:433-41.
Mangano DT, Browner WS, Hollenberg M, London MJ, Tubau JF, Tateo IM, et al. Association of perioperative myocardial ischemia with cardiac morbidity and mortality in men undergoing noncardiac surgery. The study of perioperative Ischemia Research Group. N Engl J Med, 1992.
Sawada SG, Segar DS, Ryan T, Brown SE, Dohan AM, Williams R, Fineberg NS, Armstrong WF, Feigenbaum H. Echocardiographic detection of coronary artery disease during dobutamine infusion, 1991.
Browner WS, Mangano DT, Hollenberg M, London MJ, Tubau JF. Association of perioperative myocardial ischemia with cardiac morbidity and mortality in men undergoing noncardiac surgery. The study of perioperative Ischemia Research Group, 1990.
Pellikka P, et al. Wall motion score index and ejection fraction for risk stratification after acute myocardial infarction, 2003.
