Preoperative evaluation: could age be the only risk factor that requires further diagnostic investigations?

Coviello, Antonio; Esposito, Danilo; Galletta, Roberta; Ianniello, Marilena; Maresca, Alfredo; Servillo, Giuseppe

doi:10.14744/ejmo.2020.79579

Cited by 1 publication

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“…Echocardiography could be a valuable option for low-functional elderly patients, as it can detect valvular pathologies and other unknown pathologies that are more common in elderly age groups [ 43 , 44 ]. Indeed, after encountering several complications during and after surgery, such as bradycardia, hypotension, and acute coronary syndrome in patients with undiagnosed valvular disease and where the MET score failed to screen a high-risk, the first of which was in 2020, it was decided to perform echocardiography on all patients with functional limitations with the evaluation of other scores such as METs, like RCRI and ACS-NSQIP [ 45 ].…”

Section: Discussionmentioning

confidence: 99%

Preoperative Echocardiographic Unknown Valvopathy Evaluation in Elderly Patients Undergoing Neuraxial Anesthesia during Major Orthopedic Surgery: A Mono-Centric Retrospective Study

Coviello,

Cirillo,

Vargas

et al. 2024

JCM

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Background: The assessment of cardiac risk is challenging for elderly patients undergoing major orthopedic surgery with preoperative functional limitations. Currently, no specific cardiac risk scores are available for these critical patients. Echocardiography may be a reliable and safe instrument for assessing cardiac risks in this population. This study aims to evaluate the potential benefits of echocardiography in elderly orthopedic patients, its impact on anesthesiologic management, and postoperative Major Adverse Cardiac Events (MACEs). Methods: This is a retrospective, one-arm, monocentric study conducted at ‘’Federico II’’ Hospital—University of Naples—from January to December 2023, where 59 patients undergoing hip or knee revision surgery under neuraxial anesthesia were selected. The demographic data, the clinical history, and the results of preoperative Echocardiography screening (pEco-s) were collected. After extensive descriptive statistics, the χ2 test was used to compare the valvopathies and impaired Left Ventricular Function (iLVEF) prevalence before and after echocardiography screening and the incidence of postoperative MACE; a p-value < 0.05 was considered statistically significant. Results: The mean age was 72.5 ± 6.9, and the prevalence of cardiac risk factors was about 90%. The cumulative prevalence of iLVEF and valvopathy was higher after the screening (p < 0.001). The pEco-s diagnosed 25 new valvopathies: three of them were moderate–severe. No patients had MACE. Conclusions: pEco-s evaluation could discover unknown heart valve pathology; more studies are needed to understand if pEco-s could affect the anesthetic management of patients with functional limitations, preventing the incidence of MACE, and assessing its cost-effectiveness.

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Section: Discussionmentioning

confidence: 99%