Clinical Significance Of Preoperative Transthoracic Echocardiography In Pre-anesthesia Evaluation Of Elective Laparoscopic Surgery For Colorectal Cancer

Objective: To evaluate the clinical significance of preoperative transthoracic echocardiography(TTE)in pre-anesthesia evaluation of patients undergoing elective laparoscopic colorectal cancer surgery.Methods: A single center retrospective analysis method was used in this study.From January 2018 to December 2018,a total of 1049 adult patients who were were selected for laparoscopic colorectal surgery at the Union Hospital Affiliated to Fujian Medical University were included.The subjects included 967 patients who underwent preoperative TTE examination and 82 patients who did not had preoperative TTE examination.The basic information and related clinical data of all patients were collected,and the patients with or without preoperative TTE were statistically analyzed.The patients with abnormal TTE results before operation were statistically analyzed,and multivariate logistic analysis was used for screening potential risk factors related to postoperative major adverse cardiac events(MACE).Results:No correlation was found between the physiological and pathological factors of the patients and the doctors’ decision-making of TTE(P>0.05).The overall incidence of TTE abnormality was 67.3%(664 / 967),The first three abnormalities were left ventricular diastolic dysfunction(27%),mild tricuspid regurgitation(24%)and left atrial enlargement(17%).Univariate analysis showed that preoperative TTE abnormality was correlated with age,BMI,ASA grade,history of hypertension,history of diabetes,history of ischemic cardiovascular disease,anemia,abnormal ECG and RCRI;Multivariate Logistic regression analysis showed that age(OR=1.074,P<0.001),BMI(OR=1.127,P<0.001),history of hypertension(OR=1.074,P<0.040),anemia(OR=1.529,P<0.046)and abnormal ECG(OR=0.511,P<0.001)were independent risk factors for abnormal TTE results.Univariate analysis showed that patients’ age,past medical history,abnormal ECG,ASA grade,RCRI and other physiological and pathological factors were correlated with medical decision-making;Multivariate Logistic regression analysis showed that cardiac specialist consultation was independently associated with ASA3(OR=3.115,P=0.007),age(OR=1.036,P=0.040),abnormalelectrocardiogram(OR=0.223,P=0.001)and hypoproteinemia(OR=3.520,P=0.003).;ASA3(OR=14.925,P<0.001)and age(OR=1.075,P=0.013)were independently associated with invasive monitoring;the independent factors for admission to ICU after surgery were ASA3(OR=4.464,P<0.001),age(OR=1.116,P<0.001),and serum creatinine higher than normal value(OR=30.195,P=0.003).After the physiological and pathological factors of the patients were matched by 1:1 tendency score,the study showed that there was no significant difference in medical decision-making and perioperative outcomes between the two groups with abnormal TTE results and normal TTE results before operation.Postoperative MACE occurred in 40 of the 967 patients who underwent preoperative TTE examination.The effects of preoperative physiological and pathological factors on postoperative MACE were analyzed.Univariate analysis showed that postoperative MACE was associated with age,history of cardio-cerebrovascular disease,anemia,abnormal ECG,hypoproteinemia,ASA,RCRI,abnormal results of TTE and left ventricular diastolic dysfunction and pulmonary hypertension;Multivariate Logistic regression analysis showed that age(OR=1.061,P<0.001)and history of ischemic cardiovascular disease(OR=5.182,P=0.001)were independent risk factors for postoperative MACE in patients undergoing TTE.Conclusion:Studies have shown that there is no significant correlation between the clinical decision of preoperative TTE examination and the preoperative physiological and pathological factors of patients undergoing elective laparoscopic colorectal cancer surgery.The abnormal results of TTE and the main abnormal results of TTE,including left ventricular diastolic dysfunction and pulmonary hypertension,were not shown to be independent risk factors for postoperative MACE.Preoperative TTE examination and abnormal results did not lead to changes in medical management decision-making and early clinical prognosis.