Routine Preoperative Electrocardiograms in Patients at Low Risk for Cardiac Complications During Shockwave...

Area of Science:

• Urology
• Cardiology
• Anesthesiology

Background:

• Routine preoperative electrocardiograms (ECGs) are common before shockwave lithotripsy (SWL).
• Current recommendations advise against routine ECGs for low-risk procedures in asymptomatic patients.
• The utility of preoperative ECGs in low-risk SWL patients requires further assessment.

Purpose of the Study:

• To evaluate the clinical utility of routine preoperative ECGs before SWL in low-risk patients.
• To determine if preoperative ECGs predict cancellations, intraoperative events, or postoperative complications.

Main Methods:

• Retrospective analysis of 30,892 SWL referrals and 27,722 treatments from 2003-2013.
• Review of cardiac-related preoperative cancellations, intraoperative complications, and postoperative admissions.
• Patients received SWL under sedation with continuous five-lead ECG monitoring.

Main Results:

• Preoperative ECGs led to cancellations in only 13 (0.04%) low-risk patients.
• Treatment was prematurely stopped in 5 (0.02%) patients due to arrhythmia, with no clear correlation to preoperative ECG findings.
• No patients presented with emergency department cardiac complications post-SWL.

Conclusions:

• Routine preoperative ECGs in low-risk SWL patients yield minimal cancellations and do not predict adverse cardiac events.
• The findings support omitting routine preoperative ECGs in this patient group.
• Eliminating routine ECGs may streamline care without compromising patient safety.