Level 2: Mid-level evidence

An echocardiogram is often performed prior to non­- cardiac surgery to identify patients at risk of cardiac complications even though the American College of Cardiology recommends against routine perioperative evaluation of left-ventricular function in such patients (Circulation. 2007;116:e418-e499).

A recent retrospective cohort study suggests that preoperative echocardiography may provide little benefit (BMJ. 2011;342: d3695). From a co­­hort of 264,000 patients aged 40 years and older having elective intermediate or high-risk noncardiac surgery, 35,498 patients who had a preoperative resting echocardiogram were matched to an equal number with no echocardiogram. Matching was based on multiple factors including demographics, comorbidities, type of surgery planned and hospital characteristics.

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The echocardiogram group had significantly increased mortality at 30 days (2% vs. 1.7%, P<0.05, NNH=423) and at one year (7.4% vs. 6.9%, P<0.05, NNH=222). Echocardiography was also associated with increased hospital stay (mean difference 0.31 days). There were no significant differences in surgical site infections, a marker for perioperative risk that is unaffected by echocardiogram (13.2% vs. 12.9%). A subgroup analysis showed no significant difference in one-year mortality in patients who had a preoperative stress test.