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[Guidelines for routine assessment of cardiologic surgical risk: electrocardiogram]
P Carnuccio1, M Assenza, A Lombardi
1Dipartimento di Scienze Chirurgiche e Tecnologie Mediche Applicate, Università degli Studi La Sapienza, Roma.
Insights
Routine preoperative electrocardiograms (ECGs) are not recommended for all non-cardiac elective surgeries. Clinical assessment should guide the decision for ECGs in patients with high cardiac risk.
Area of Science:
- Cardiology
- Anesthesiology
- Perioperative Medicine
Context:
- Cardiac complications are a leading cause of perioperative mortality.
- Preoperative cardiac evaluation, including electrocardiograms (ECGs) and cardiologist consultations, is standard practice to mitigate surgical risks.
- The study evaluated 1715 patients undergoing surgery to assess the utility of routine preoperative ECGs.
Purpose:
- To determine the predictive value and efficacy of routine preoperative electrocardiograms (ECGs) as a first-level test in non-cardiac elective surgery.
- To ascertain if systematic ECG screening is a cost-effective and beneficial practice for all surgical patients.
- To establish evidence-based guidelines for preoperative cardiac risk assessment.
Summary:
- A systematic evaluation of 1715 patients found that routine preoperative electrocardiograms (ECGs) are not indicated for all non-cardiac elective surgeries.
- The study suggests that ECGs should be reserved for patients identified as high-risk through thorough clinical and anamnestic examination.
- Clinical judgment should serve as the primary tool for determining the necessity of an ECG as a second-level test.
Impact:
- This research can refine preoperative cardiac risk stratification protocols.
- It may lead to more targeted and efficient use of diagnostic resources in perioperative care.
- Implementing these findings could reduce unnecessary testing and associated healthcare costs while optimizing patient safety.
Abstract:
Cardiac complications are the main cause of perioperative mortality. A preoperative electrocardiogram and cardiologist's consultation are usually performed to get information about cardiac state of patients undergoing surgery and to prevent complications. In their study the Authors applied to 1715 patients undergoing surgery an evaluation schedule for the cardiac surgical risk, including an ECG as first-level test, performed systematically on the whole sample. The aim was to assess predictive value of this preoperative examination to verify its efficacy as routine test. Basing on results achieved, electrocardiogram is not routinely indicated before noncardiac elective surgery, but it should be requested for the patients having high risk of cardiac complications at an accurate clinical-anamnestic examination. Therefore, clinical judgement, that is the first level of any preoperative evaluation, should be the basis for ordering an ECG to be considered a second-level test.