Related Experiment Video

Updated: Nov 1, 2025

Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
07:41

Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure

Published on: February 8, 2022

4.0K

Appropriateness of transthoracic echocardiography in preoperative elective joint arthroplasty patients

Victor Yuan1, Brian S Cowie1

  • 1Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital Melbourne, Melbourne, Australia.

Journal of Perioperative Practice
|June 28, 2021
PubMed

Insights

Preoperative transthoracic echocardiography (TTE) is frequently used in elective joint arthroplasty patients, but nearly half of these cardiac evaluations are inappropriate. Unnecessary TTE scans significantly delay surgery for patients undergoing joint replacement.

Area of Science:

  • Cardiology
  • Orthopedic Surgery
  • Medical Imaging

Background:

  • Postoperative cardiovascular complications affect up to 3% of elderly patients undergoing elective joint arthroplasty.
  • Preoperative cardiac evaluation, including transthoracic echocardiography (TTE), can aid risk stratification for non-cardiac surgery.
  • Optimizing perioperative outcomes in joint arthroplasty patients is crucial.

Purpose of the Study:

  • To assess the frequency, indications, appropriateness, and consequences of preoperative TTE in elective joint arthroplasty patients.
  • To evaluate the impact of TTE on surgical timing and patient outcomes.
  • To determine adherence to international guidelines for preoperative cardiac imaging.

Main Methods:

  • A one-year retrospective audit of patients undergoing elective joint arthroplasty at St Vincent's Hospital Melbourne.
  • Data collection included patient demographics, TTE indications, and timing relative to surgery.
  • Appropriateness of TTE was judged against established international guidelines.

Main Results:

  • Of 493 patients without recent TTE, 192 (39%) underwent a preoperative resting TTE.
  • Only 92 (48%) of ordered TTEs were deemed appropriate based on guidelines.
  • TTE led to a significant average delay of 31 days in the time to surgery.

Conclusions:

  • A substantial proportion of elective joint arthroplasty patients undergo preoperative TTE without clear indication.
  • Inappropriate TTE utilization contributes to significant delays in surgical scheduling.
  • Reviewing TTE ordering practices may improve perioperative care efficiency and reduce unnecessary testing.

Keywords:
Clinical auditJoint arthroplastyPerioperative medicinePreoperativeTransthoracic echocardiogram

More Related Videos

Noninvasive Determination of Vortex Formation Time Using Transesophageal Echocardiography During Cardiac Surgery04:48

Noninvasive Determination of Vortex Formation Time Using Transesophageal Echocardiography During Cardiac Surgery

Published on: November 28, 2018

8.1K
Echocardiographic Assessment Using Subxiphoid-Only Examination for Hypotensive Patients08:45

Echocardiographic Assessment Using Subxiphoid-Only Examination for Hypotensive Patients

Published on: April 18, 2025

661

Related Concept Videos

Imaging Studies for Cardiovascular System II:Types of Echocardiography01:20

Imaging Studies for Cardiovascular System II:Types of Echocardiography

Echocardiography plays a role in assessing cardiac health and detecting heart conditions, with various types providing critical insights for diagnosis and treatment.
Types of Echocardiography
Transthoracic Echocardiography (TTE)
TTE is the most common type of echocardiogram which involves placing a transducer on the patient's chest, emitting sound waves to create heart images. TTE is invaluable for evaluating the heart's size, structure, and motion, making it particularly useful for...
442
Imaging Studies for Cardiovascular System I:Echocardiography01:17

Imaging Studies for Cardiovascular System I:Echocardiography

Cardiac imaging studies encompass a wide range of noninvasive and minimally invasive techniques designed to visualize the heart's structure and function in detail. One such technique is echocardiography, which uses high-frequency ultrasound waves to produce detailed images of the heart, known as echocardiograms.
Indications: Echocardiography is utilized to diagnose heart failure, valve disorders, and myocardial infarction. It also assesses cardiac structures' size, shape, and motion,...
542
Rheumatic Heart Disease II: Clinical Manifestations and Diagnostic Studies01:22

Rheumatic Heart Disease II: Clinical Manifestations and Diagnostic Studies

The key clinical manifestations of Rheumatic heart disease (RHD) include several distinct cardiac symptoms.Carditis, a hallmark of acute rheumatic fever, involves inflammation of the heart's endocardium, myocardium, and pericardium. Chronic RHD often results from recurrent episodes of carditis. Its symptoms include the following:Murmurs are caused by valvular damage, especially to the mitral and aortic valves. Mitral stenosis or regurgitation is common, with characteristic heart murmurs...
157
Cardiomyopathy VII: Pre and Post Operative Nursing Management01:28

Cardiomyopathy VII: Pre and Post Operative Nursing Management

Patients with hypertrophic cardiomyopathy (HCM) and left ventricular outflow tract (LVOT) obstruction who remain symptomatic despite optimal medical therapy may undergo a septal myectomy (Morrow procedure). This procedure involves excising a portion of the hypertrophied septum below the aortic valve using a heart-lung machine to improve blood flow through the LVOT. Effective preoperative and postoperative nursing management ensures successful patient outcomes, minimizes complications, and...
82
Mitral Valve Prolapse II: Assessment and Management01:22

Mitral Valve Prolapse II: Assessment and Management

IntroductionA range of clinical features characterizes Mitral Valve Prolapse (MVP), but it is important to note that many individuals with MVP are asymptomatic and may remain so throughout their lives. For those who do exhibit symptoms, the following are the key clinical features:Palpitations: This is a common symptom where individuals feel an irregular or rapid heartbeat. Palpitations in MVP are often due to arrhythmias such as premature ventricular contractions or supraventricular...
106
Ultrasonography01:17

Ultrasonography

Ultrasonography is an imaging technique that uses high-frequency sound waves to visualize the body's internal structures. It is a non-invasive and safe procedure that does not involve the use of ionizing radiation, making it widely used in various medical fields. Ultrasonography is used to study heart function, blood flow in the neck or extremities, certain conditions such as gallbladder disease, and fetal growth and development.
During an ultrasonography procedure, a handheld device called...
6.8K