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Evaluation of the efficacy of routine preoperative electrocardiograms
A R Tait1, H G Parr, K K Tremper
1Department of Anesthesiology, University of Michigan Medical Center, Ann Arbor 48109, USA.
Insights
Routine preoperative electrocardiograms (ECG) do not reliably predict cardiovascular complications in healthy patients undergoing elective surgery. Current screening criteria may lead to unnecessary tests, impacting cost-effectiveness.
Area of Science:
- Cardiology
- Anesthesiology
- Health Services Research
Background:
- Preoperative electrocardiograms (ECG) are commonly used to assess cardiovascular risk.
- The utility of routine ECGs in low-risk surgical patients remains debated.
- Optimizing preoperative testing can improve healthcare efficiency.
Purpose of the Study:
- To evaluate the predictive value of routine preoperative ECGs for perioperative cardiovascular complications.
- To assess the efficacy of ECG screening in essentially healthy individuals undergoing elective surgery.
- To inform guidelines regarding preoperative ECG ordering.
Main Methods:
- Retrospective chart review of 1000 adult patients (ASA class I and II).
- Analysis of preoperative ECG results and perioperative cardiovascular events.
- Comparison of ECG findings and outcomes between patients with and without cardiovascular risk factors.
Main Results:
- Fifty-seven percent of patients had a preoperative ECG; 37.8% were abnormal.
- Patients with cardiovascular risk factors had more abnormal ECGs (51%) than those without (26.1%).
- No significant difference in perioperative events was observed between groups, and ECG results showed limited predictive value.
Conclusions:
- Routine preoperative ECG screening is a poor predictor of perioperative complications in healthy patients.
- Current criteria for preoperative ECGs may result in unnecessary testing and reduced cost-effectiveness.
- Revising ECG ordering guidelines could enhance resource allocation and patient care.
Objective:
To evaluate the efficacy of routine preoperative electrocardiograms (ECG) in predicting perioperative cardiovascular complications in an essentially healthy population.
Design:
Retrospective chart review.
Setting:
The adult hospital of a large academic medical center.
Participants:
One thousand ASA class I and II adult patients undergoing a number of different elective surgical procedures.
Interventions:
None.
Measurements And Main Results:
The mean age of the population was 48 years (range, 18 to 88), and 53% were female. Fifty-seven percent of the population had a preoperative ECG, of which 56.5% were considered normal, 37.8% were abnormal, and 6.6% were considered borderline. Twenty-seven percent of the population presented with cardiovascular risk factors, and of these, 93.2% had an ECG performed. Seventy-three percent of patients had no cardiovascular risk factors, and of these, 44.5% had a preoperative ECG. Patients who had cardiovascular risk factors had significantly more abnormal ECGs than those without (51% v 26.1%,); however, there was no difference in the prevalence of perioperative events between the two groups. The positive predictive value of an abnormal ECG for a perioperative event was slightly greater for patients with cardiovascular risk factors than for those without (42.7% v 34.7%, respectively); however, this difference was not significant. In addition, a normal ECG was just as predictive as an abnormal one.
Conclusions:
Results of this study suggest that the practice of routine ECG screening for patients with no cardiovascular risk factors is a poor predictor of perioperative complications in this patient population. A review of the current criteria for ordering preoperative ECGs may reduce the number of unnecessary tests and improve cost-effectiveness.