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Published byKelly Spencer Modified over 8 years ago
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Journal Club: Preoperative Electrocardiograms Troy Tada, DO August 26, 2009
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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
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Choice of article EKG utilitized on a daily basis Improve criteria for preoperative EKG ordering Ways how we can improve cost and resources
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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
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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
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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)
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Results
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However, 5 pts (0.44%) in the significantly abn group were under 65 years of age and did not have any RF
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Bottom line Independent RF increasing probability of having significantly abn EKG –High cholesterol –Age > 65 –Severe valvular dz, –MI –Angina –CHF
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Bottom line EKG abn that should prompt the preoperative doc to request further info, consultation, or testing are controversial. –Variability based on physicians
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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
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Open Discussion
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