Perioperative medicine & outcomes
Age-Based Preoperative Transthoracic Echocardiography, Intraoperative Hypotension, and Postoperative Outcomes in Older Adults Undergoing Noncardiac Surgery: A Regression Discontinuity Analysis
Main finding · Intraoperative hypotension (IOH), defined as the duration of mean arterial pressure <65 mm HgResult — go to the resultLocal effect (difference in IOH duration) 24.8-minute reduction minutes 95% CI −71.1 to 21.5Authors' conclusion
Using a quasi-experimental design that reduces susceptibility to confounding by indication, we found no clear evidence that routine age-based preoperative TTE reduced IOH or improved postoperative outcomes near the threshold. The estimates were imprecise, and clinically meaningful benefit or harm could not be excluded. These findings suggest that age alone may be insufficient to justify routine preoperative TTE and support further evaluation of selective risk-based strategies.
Study context
- Population
- Patients aged 60 to 89 years undergoing elective noncardiac surgery under general anesthesia from July 2017 to August 2024, excluding those with guideline-based indications or other clinical conditions likely to prompt preoperative TTE independent of agepatients analysed
- Participants
- 7,270 patients
- Exposure
- Local effect of routine age-based preoperative TTE at the 75-year-old cutoff
- Outcome
- Intraoperative hypotension (IOH), defined as the duration of mean arterial pressure <65 mm Hg
Methodological detailsfuzzy regression discontinuity design, quasi-experimental design
- Fuzzy regression discontinuity design
- Quasi-experimental design
Main finding
As reported in the abstract
Local effect (difference in intraoperative hypotension (IOH) duration)
24.8-minute reduction minutes
95% CI −71.1 to 21.5
Observational data: associations, not effects.
Secondary outcomes
| Outcome | Estimate |
|---|---|
| 30-day mortality (exploratory secondary) · imprecise | local effect −2.1% (95% CI −6.0 to 1.8) |
| 90-day mortality (exploratory secondary) · imprecise | local effect −3.2% (95% CI −10.4 to 3.9) |
| AKI (exploratory secondary)Imprecise | local effect −3.6% (95% CI −15.9 to 8.6) |
| Unplanned ICU or CCU admission (exploratory secondary) | local effect −6.0 percentage points (95% CI −12.2 to 0.2) |
| Postoperative length of hospital stay (exploratory secondary) | local effect −7.0 days (95% CI −14.6 to 0.5) |
Probability of undergoing preoperative TTE at the 75-year-old cutoff (first stage)
- Increase in probability of undergoing preoperative TTE (percentage points)
- 43.1
- 95% CI, 33.3-52.9
- Strong first-stage discontinuity
Continuity of baseline characteristics and density of the running variable (age)
- No clear discontinuity at the cutoff
Original publication
Composed by AI from the published abstract and checked against it. How Briefs are made →