The effects of preoperative focused cardiac ultrasound in high-risk patients: A randomised controlled trial (PREOPFOCUS)

Jan Pallesen, Rajesh Bhavsar, Jesper Fjølner, Skule Arnesen Bakke, Jan Krog, Mikkel Andreas Strømgaard Andersen, Michael Helbo Bøndergaard, Thomas Damgaard Jessing, Lone Mortensen, Michael Bugge Nielsen, Marianne Vang, Laima Malachauskiené, Peter Juhl-Olsen*

*Corresponding author for this work

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Abstract

Background: Surgery is the third most common cause of mortality worldwide. Focused cardiac ultrasound (FOCUS) yields information on cardiac status and discloses the presence of unknown pathology. Preoperative FOCUS changes patient treatment, allowing for a patient-tailored anaesthesia. We hypothesised that preoperative FOCUS would reduce the proportion of patients who were either admitted to hospital for more than 10 days or who were dead within 30 days after high-risk, non-cardiac surgery. Methods: This was a randomised, controlled, multi-center study. Patients ≥65 years of age, admitted for urgent orthopaedic- or abdominal surgery, scheduled for general- or neuraxial anaesthesia and with ASA 3/4 were eligible for inclusion. Patients were randomised in a 1:1 ratio to preoperative FOCUS or no preoperative FOCUS performed in accordance with a predefined protocol. Primary endpoint was the proportion of patients admitted more than 10 days or who were dead within 30 days. Secondary endpoints included major complications, days of admission and changes in anaesthesia handling. Results: During the second COVID-19 wave the study monitoring committee terminated the study prematurely. We included 338 patients of which 327 were included in the final analysis. In the FOCUS group, 41/163 (25%) patients met the criteria for the primary endpoint versus 35/164 (21%) for the control group, adjusted odds ratio 1.37 (95% CI 0.86–2.30), p =.36. The proportions of patients who developed major complications did not differ significantly between groups. Length of hospital stay was 4 (3–8) days in the FOCUS group and 4 (3–7) days on the control group (adjusted p =.24). Conclusion: The routine availability of preoperative FOCUS assessment in this cohort does not appear to reduce the risk for hospitalisation exceeding 10 days or 30-day mortality, although study enrolment was prematurely terminated.

Original languageEnglish
JournalActa Anaesthesiologica Scandinavica
Volume66
Issue number10
Pages (from-to)1174-1184
ISSN0001-5172
DOIs
Publication statusPublished - Nov 2022

Bibliographical note

Publisher Copyright:
© 2022 The Authors. Acta Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation.

Keywords

  • anaesthesiology
  • echocardiography
  • surgery
  • COVID-19
  • Length of Stay
  • Heart
  • Humans
  • Ultrasonography
  • Hospitalization

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