Journal Club: Preoperative Electrocardiograms Troy Tada, DO August 26, 2009

End points of Study Target patients who will likely have an EKG abn that would likely affect preoperative management Determine if age, alone, is predictive of significant abnormalities

Choice of article EKG utilitized on a daily basis Improve criteria for preoperative EKG ordering Ways how we can improve cost and resources

Method Weiner Center for Preoperative evaluation at Brigham and Women’s Hospital (Boston) –1,149 EKG’s reviewed and interpreted by staff cardiologist –Pts with significant abn EKG were compared to a control group randomly selected from the remaining pts in the study –RF for each patient were listed

Method Significantly abn EKG –Census of anesthesiology and cardiology group in this study required further assessment of evaluation before preceding to surgery –Significant Q waves, major ST segment depression, major T wave changes, ST segment elevation, Morbitz type II or higher blockade, LBBB, and afib

Results Most common abn was minor T wave changes (186 pts, 16.2 % of EKG reviewed) Most common significant abn was major T wave changes (57 pts, 5% of EKGs)

Results

However, 5 pts (0.44%) in the significantly abn group were under 65 years of age and did not have any RF

Bottom line Independent RF increasing probability of having significantly abn EKG –High cholesterol –Age > 65 –Severe valvular dz, –MI –Angina –CHF

Bottom line EKG abn that should prompt the preoperative doc to request further info, consultation, or testing are controversial. –Variability based on physicians

Limitation Retrospective study RF could have been further subdivided No analysis of the subsequent impact of the clinician’s response t EKG on postoperative outcomes

Open Discussion