Echo at 75 by policy did not clearly change perioperative outcomes

Design

Single-centre retrospective fuzzy regression discontinuity analysis

Population

7,270 patients aged 60–89 having elective non-cardiac surgery

Primary outcome

Duration of intraoperative MAP <65 mm Hg

Effect

−24.8 min (95% CI −71.1 to 21.5)

A single-centre study used a hospital rule, routine transthoracic echocardiography for everyone aged 75 or over before elective non-cardiac surgery, as a natural experiment. Comparing 7,270 patients aged 60 to 89 just either side of the cutoff, with guideline indications for echo excluded, isolates the effect of the age-triggered scan.

Crossing 75 raised the chance of a preoperative echo by 43 percentage points. The estimated effect on intraoperative hypotension was a 24.8-minute reduction, but with a wide interval (−71.1 to +21.5). Mortality, acute kidney injury, unplanned ICU admission and length of stay all had point estimates favouring echo, but none was statistically clear.

Regression discontinuity reduces confounding by indication, which bedevils most studies of preoperative testing. Its weakness is imprecision, and the authors are explicit that meaningful benefit or harm cannot be excluded.

What it supports is the existing guideline position: order preoperative echo for a clinical reason, such as unexplained dyspnoea, a new murmur or suspected heart failure, rather than for age alone.

• Order preoperative echocardiography for a clinical indication, not for age alone.
• Look for unexplained breathlessness, murmurs or signs of heart failure in older patients.
• Review local policies that trigger tests automatically by age.
• Plan blood pressure management for older patients whether or not they have had an echo.

Why it matters

Routine age-triggered echo adds delay and cost without clear evidence of changing outcomes.

Don't overread it

Wide intervals mean a meaningful benefit or harm could not be excluded; this is absence of evidence, not evidence of no effect.

The statistics, in plain English

An interval from −71 to +21 minutes for hypotension means echo could have cut hypotension substantially or slightly increased it. Regression discontinuity compares patients just above and below age 75, who should be similar except for the policy, which makes the comparison fairer than ordinary observational studies.

Read the rest in the app

You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.

Get Daily Doctor — free

Scan to keep reading on your phone. No account needed to start.