Vnitr Lek 2024, 70(8):E3-E10 | DOI: 10.36290/vnl.2024.103

Value of electrocardiogram and chest X-ray examinations in preoperative management

Bronislav Čapek^{1, 2}, Jan Václavík^{3, 4}, Klára Benešová⁵, Jiří Jarkovský⁵

¹ Department of Internal Medicine, Associated Medical Facility Krnov, Krnov, Czech Republic

² Faculty of Medicine and Dentistry, Palace University Olomouc, Olomouc, Czech Republic

³ Department of Internal Medicine and Cardiology, University Hospital Ostrava, Ostrava, Czech Republic

⁴ Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic

⁵ Institute of Biostatistics and Analyses, Masaryk University, Brno, Czech Republic

Aims: An electrocardiogram (ECG) and chest X-ray (CXR) are widely used in the preoperative period for patients undergoing non-cardiac surgery (NCS). We aimed to assess whether preoperative ECG and CXR had any impact on changes in preoperative management for an unselected population undergoing non-elective NCS.

Methods: We retrospectively reviewed records of hospitalized patients undergoing an internal preoperative examination in 2015-2021. The primary endpoint was a change in preoperative management that caused postponement or complete cancelation of a surgery (PCCS), due to an abnormal ECG or CXR.

Results: We enrolled 2362 patients. 72% had an abnormal ECG and 33% had an abnormal CXR. PCCS due to an abnormal ECG or CXR occurred in 4 (0.17%) and 5 (0.21%) patients, respectively. In all cases, the change in preoperative management was due to a supraventricular tachyarrhythmia (SVT) on the ECG or pneumonia on the CXR. Patients with PCCS due to SVT had a rapid heart rate (HR) (mean 141 bpm vs. 79 bpm in others). An HR cut-off value <125 bpm had a 100% negative predictive value (NPV) for PCCS. Patients with PCCS due to pneumonia had higher C-reactive protein levels (CRP) (median 189 mg/l vs. 7 mg/l in others). A CRP cut-off value <62 mg/l had 100% NPV for PCCS. There was an increased 90-day postoperative all-cause mortality risk in patients with HR above 100 bpm (RR=2.08), increasing even more with higher HRs, and abnormal CXR findings compared to normal CXR (RR=2.49).

Conclusions: Both ECG and CXR had very limited value in the preoperative management of hospitalized patients undergoing non-elective NCS. We recommend HR (>100 bpm) and CRP (>61 mg/l) as indicators for ECG and CXR testing, rather than age, as an addition to patient history and clinical findings. HR above 124 bpm should distinguish the patients with higher probability of changes in preoperative management. We also recommend using an abnormal CXR (if available) and a heart rate exceeding 100 bpm to identify patients at a higher relative risk of postoperative mortality.

Keywords: Arrhythmias, C-Reactive Protein, Electrocardiography, Pneumonia, Retrospective Studies, X-rays

Accepted: December 13, 2024; Published: December 18, 2024  Show citation