Routine echocardiography at age 75 did not clearly change intraoperative hypotension or outcomes

Design

Single-centre fuzzy regression discontinuity analysis

Population

7,270 adults aged 60-89 having elective noncardiac surgery without a guideline indication for echo

Primary outcome

Duration of intraoperative mean arterial pressure below 65 mmHg

Effect

-24.8 minutes (95% CI -71.1 to 21.5) attributable to preoperative echo

A single centre had a policy of routine preoperative transthoracic echocardiography for everyone aged 75 or over. Researchers used that cut-off as a natural experiment: patients just under and just over 75 are otherwise similar, so differences can be attributed to the echo. They included 7,270 patients aged 60-89 having elective noncardiac surgery, excluding anyone with a guideline-based reason for echo.

Crossing 75 raised the chance of having echo by 43 percentage points. The estimated effect of echo on time with mean arterial pressure below 65 mmHg was a reduction of 24.8 minutes, but with a confidence interval from -71 to +22 minutes. Estimates for mortality, kidney injury, unplanned ICU admission and length of stay all pointed towards benefit but were imprecise and crossed no effect.

The honest reading is that age alone did not clearly justify routine echo, and that meaningful benefit or harm cannot be excluded. For Indian preoperative clinics, where echo capacity is limited and delays cancel surgery, this supports ordering it for a clinical indication rather than a birthday.

• Order preoperative echocardiography for a clinical indication, such as a new murmur, unexplained breathlessness or suspected heart failure, not for age alone.
• Use history, functional capacity and established risk indices to decide who needs further cardiac testing.
• Avoid delaying surgery for an echo requested only because the patient is over 75.
• Plan blood pressure management for older patients whether or not an echo is available.

Why it matters

Age-triggered echo uses scarce capacity and can delay surgery without clear evidence of benefit.

Don't overread it

The estimates were imprecise; the study cannot rule out a worthwhile benefit from echo in older adults.

The statistics, in plain English

Regression discontinuity compares people just either side of an arbitrary cut-off, which mimics randomisation near that age. The 24.8-minute reduction has an interval from 71 minutes less to 22 minutes more, so the data fit benefit, no effect or slight harm.

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