Preoperative Diastolic Dysfunction and Postoperative Outcomes after Noncardiac Surgery

Objective: To determine if diastolic dysfunction is independently associated with increased mortality, acute kidney injury, and hospital length of stay after noncardiac surgery. Design: Retrospective observational cohort. Setting: Academic referral center. Participants: All patients undergoing noncardiac and nonliver-transplant surgeries at University of California - Los Angeles between April 2013 and October 2017, who also had transthoracic echocardiograms performed within 6 months preceding their procedures. Interventions: None. Measurements and Main Results: Patients’ demographic, comorbidity, echocardiographic, and perioperative data were queried from the electronic health record. Diastolic dysfunction was graded by automated application of 2016 American Society of Echocardiography guidelines to queried echocardiographic measurements. During the study period, 12,871 eligible records were identified, of which 7,312 represented unique procedures with complete information. Twenty-three percent of patients had echocardiographic evidence of diastolic dysfunction (7.0% grade 1, 8.1% grade 2, 0.6% grade 3, and 7.5% nonspecific). Patients with diastolic dysfunction tended to be older and have higher American Society of Anesthesiologists scores with more comorbidities. Overall, 166 patients (2.3%) experienced an in-hospital death. After adjustment for potentially confounding variables, diastolic dysfunction was not significantly associated with increased in-hospital mortality, acute kidney injury, or hospital length of stay. Conclusions: Diastolic dysfunction does not appear to be associated with increased in-hospital mortality, acute kidney injury, or hospital length of stay in a cohort of noncardiac surgical patients at an academic medical center. These results highlight uncertainties in perioperative risk determination.