Perioperative Stepwise Assessment of Cardiac Patients in Non-Cardiac Surgery During Laparoscopic Cholecystectomy

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Cardiovascular disease or risk factors in patients undergoing elective laparoscopic cholecystectomy (n=50). Intervention: Stepwise preoperative cardiovascular assessment (RCRI ≥2) vs. RCRI 0-1. Primary outcome: Clinically relevant postoperative complications (p=0.041).

Q: What does this research mean for the field?

Preoperative high-risk cardiac assessment findings, including RCRI score ≥2, poor functional capacity, elevated natriuretic peptides, and abnormal echocardiography, are associated with increased postoperative complications during laparoscopic cholecystectomy. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

Nusrat Hossain; Abdul Khaleque Beg; Mahmud Riyad Faisal; Ashikur Rahman

doi:10.70818/apjmi.v03i03.057

September 30, 2026Asia Pacific Journal of Medical InnovationsOpen Access

Perioperative Stepwise Assessment of Cardiac Patients in Non-Cardiac Surgery During Laparoscopic Cholecystectomy

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Why the study?

Patients with cardiovascular disease or risk factors may develop cardiovascular complications during laparoscopic cholecystectomy due to pneumoperitoneum, altered venous return, anaesthesia, and surgical stress. Stepwise preoperative cardiac assessment using RCRI, functional capacity, ECG, BNP, NT-proBNP, and echocardiography may help identify vulnerable patients and guide perioperative management.

Does a stepwise preoperative cardiac assessment incorporating RCRI, functional capacity, ECG, BNP, NT-proBNP, and targeted echocardiography identify patients at higher risk for perioperative cardiovascular complications during elective laparoscopic cholecystectomy?

Key Points

To evaluate the utility of a stepwise preoperative cardiac assessment pathway and observe perioperative haemodynamic changes and short-term postoperative outcomes in patients undergoing laparoscopic cholecystectomy.
Prospective observational study of 50 adults with cardiovascular disease or risk factors undergoing elective laparoscopic cholecystectomy at Popular Medical College Hospital in Dhaka from January 2023 to December 2025.
Preoperative stepwise evaluation incorporated RCRI, functional capacity (METS), 12-lead ECG, BNP, NT-proBNP, and targeted transthoracic echocardiography.
Intraoperative haemodynamics and postoperative outcomes—including cardiovascular complications, HDU/ICU admission, oxygen requirement, hospital stay, and mortality—were monitored.
Postoperative complications occurred in 10 patients (20.0%), including hypotension in 4 (8.0%), hypertension in 3 (6.0%), new arrhythmia in 2 (4.0%), suspected myocardial injury in 2 (4.0%), and heart failure symptoms in 1 (2.0%), with 0 perioperative deaths.
Preoperative screening identified RCRI ≥2 in 14 patients (28.0%), functional capacity <4 METS in 18 (36.0%), abnormal ECG in 18 (36.0%), elevated BNP in 14 (28.0%), elevated NT-proBNP in 12 (24.0%), and abnormal echocardiograms in 15 (30.0%).
Postoperative complications were more frequent among patients with RCRI ≥2, functional capacity <4 METS, elevated BNP or NT-proBNP concentrations, and abnormal echocardiographic findings.

Study Design

Type

Observational (n=50)

Multicenter

No

Structured PICO

Does a stepwise preoperative cardiac assessment incorporating RCRI, functional capacity, ECG, BNP, NT-proBNP, and targeted echocardiography identify patients at higher risk for perioperative cardiovascular complications during elective laparoscopic cholecystectomy?

P

Population

50 adults (mean age 57.6 years, 42% female) with cardiovascular disease or risk factors undergoing elective laparoscopic cholecystectomy in Bangladesh, monitored during the perioperative period.

E

Exposure

Stepwise preoperative cardiac assessment pathway incorporating Revised Cardiac Risk Index (RCRI), functional capacity (METS), standard 12-lead ECG, natriuretic peptides (BNP and NT-proBNP), and targeted transthoracic echocardiography, combined with standardized intraoperative haemodynamic monitoring

O

Outcome

Clinically relevant postoperative complications (defined as events requiring medical intervention or additional postoperative monitoring, including haemodynamic instability/hypotension/hypertension, new arrhythmia, suspected myocardial ischaemia/injury, heart-failure symptoms, prolonged oxygen requirement, HDU/ICU admission, prolonged hospital stay, and perioperative mortality)composite

Main Result

Absolute Event Rate: 35.7% vs 13.9%

p-value: p=0.041

Stepwise preoperative cardiovascular assessment combining clinical risk (RCRI), functional capacity, ECG, natriuretic peptides, and targeted echocardiography effectively stratifies perioperative complication risk in cardiac patients undergoing laparoscopic cholecystectomy, supporting guideline-recommended selective testing.

Limitations

Small sample size of 50 patients with limited statistical power for uncommon cardiovascular outcomes
Observational design prevents determination of whether the assessment strategy itself reduced postoperative complications
Laparoscopic cholecystectomy is associated with a lower cardiovascular event rate than major vascular or thoracic surgery, limiting generalizability
Subjective estimation of METS without formal cardiopulmonary exercise testing may introduce measurement error
BNP and NT-proBNP concentrations may be confounded by age, renal function, atrial fibrillation, and ventricular loading conditions
Reliance on clinical assessment rather than routine postoperative high-sensitivity cardiac troponin for myocardial injury
Relatively small sample size (n=50), preventing proof of independent predictive performance
Subjective estimation of functional capacity (METS) rather than standardized tools like DASI
Relied primarily on clinical assessment for suspected myocardial injury rather than routine biomarker screening

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Implication

May aid preoperative risk stratification in laparoscopic cholecystectomy; hypothesis-generating for prospective intervention trials.

Abstract

Background: Patients with cardiovascular disease or risk factors may develop haemodynamic instability, myocardial injury, arrhythmia or heart failure during non-cardiac surgery. Laparoscopic cholecystectomy may cause cardiovascular changes due to pneumoperitoneum, altered venous return, anaesthesia and surgical stress. Stepwise preoperative cardiac assessment may help identify vulnerable patients and guide perioperative management. Objective: To evaluate the role of stepwise cardiac assessment using RCRI, functional capacity, ECG, BNP, NT-proBNP and echocardiography in patients undergoing laparoscopic cholecystectomy and to assess perioperative haemodynamic changes and short-term outcomes. Methods: This prospective observational study included 50 adults with cardiovascular disease or relevant cardiovascular risk factors undergoing elective laparoscopic cholecystectomy at Popular Medical College Hospital, Dhaka, from January 2023 to December 2025. Preoperative assessment included RCRI, METS, ECG, BNP, NT-proBNP and targeted echocardiography. Intraoperative haemodynamic and respiratory parameters were monitored. Postoperative outcomes included cardiovascular complications, oxygen requirement, HDU/ICU admission, prolonged hospital stay and mortality. Results: The mean age of the patients was 57.6±10.8 years and 29 (58.0%) were male. RCRI scores were 0 in 20.0%, 1 in 36.0%, 2 in 30.0% and 3 in 14.0%. Poor functional capacity (<4 METS) was present in 36.0%. ECG abnormalities were identified in 36.0%, elevated BNP in 28.0%, elevated NT-proBNP in 24.0% and echocardiographic abnormalities in 30.0%. Ten patients (20.0%) experienced at least one clinically relevant postoperative complication. Complications were more frequent among patients with RCRI ≥2, functional capacity <4 METS, elevated BNP or NT-proBNP and abnormal echocardiographic findings. No perioperative death occurred. Conclusion: A stepwise perioperative cardiac assessment incorporating clinical risk, functional capacity, ECG, natriuretic peptides and targeted echocardiography may help identify patients requiring enhanced perioperative surveillance during laparoscopic cholecystectomy. The findings support individualized cardiovascular evaluation rather than indiscriminate cardiac testing.

Discussion

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Cite This Study

Hossain et al. (2026) conducted an observational in Cardiovascular disease or risk factors in patients undergoing elective laparoscopic cholecystectomy (n=50). Stepwise preoperative cardiovascular assessment (RCRI ≥2) vs. RCRI 0-1 was evaluated on Clinically relevant postoperative complications (p=0.041).

synapsesocial.com/papers/6ae28e0ecbadf70daf6c4044 https://doi.org/10.70818/apjmi.v03i03.057

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Perioperative Stepwise Assessment of Cardiac Patients in Non-Cardiac Surgery During Laparoscopic Cholecystectomy

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Perioperative Stepwise Assessment of Cardiac Patients in Non-Cardiac Surgery During Laparoscopic Cholecystectomy

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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