Evaluation of the Age-Based Pre-Anesthesia Screening ECG: An Analysis of Efficacy and Predictive Potential in Outpatient Surgery

Abstract

BackgroundTo avoid perioperative cardiac events, institutions have adopted electrocardiogram (ECG) protocols and clinical history evaluations preoperatively. While 2014 American Heart Association guidelines suggested clinical history was sufficient for evaluation in low-risk outpatient surgeries, the demographics evaluated were different from the regional profile in which we work. Thus, this study compared an age-based pre-operative ECG protocol with clinical history to determine predictive value concerning adverse perioperative cardiac events. MethodsAll patients 50-59 years (ASA 1-3) who underwent low-risk outpatient surgical procedures at a single outpatient surgical center in a 12-month period were evaluated. Typical demographic data was collected. Pre-operative ECG data, comorbidities, and the results of perioperative care were also evaluated. These data were compared to previously published results. ResultsOf 761 patients analyzed, 72 patients (9%) had ECGs with tracings which warranted further chart review. Four of these 72 patients were referred to the cardiologist by the anesthesiologist for a pre-operative evaluation (.5% of the entire cohort), and one subsequently required a coronary artery bypass grafting before their procedure could commence. None of the 72 patients with potentially significant ECGs had an adverse perioperative cardiac event. We also demonstrated significant relationships between different sets of comorbidities within the cohort with clinically significant ECGs. ConclusionsThese findings reveal an opportunity to lessen the burden of time and cost with respect to pre-operative assessment for both the patient and the institution by relying on clinical history except in obese patients for whom cardiac complications are probabilistic, incurring more perioperative risk.