Prognostic Value of Preoperative Electrocardiogram in Low-Risk Patients Undergoing Surgical Intervention and General Anesthesia

Ramos, Lafayete; Coutinho, Alexandre Chataubriand; Rebelato, José; Ramos, Marcos Vinicius; Elly, Eliane; Amoedo, Pedro; Viel, Gustavo; Moises, Valdir Ambrósio

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Arquivos Brasileiros de Cardiologia

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Original Article • Arq. Bras. Cardiol. 121 (1) • Jan 2024 • https://doi.org/10.36660/abc.20230098 copy

Prognostic Value of Preoperative Electrocardiogram in Low-Risk Patients Undergoing Surgical Intervention and General Anesthesia

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background

Patients aged over 50 years require four times more surgical interventions than younger groups. Many guidelines recommend the performance of preoperative electrocardiogram (ECG) in this population.

Objectives

To determine the value of preoperative ECG in patients aged over 50 years and classified as ASA I–II (surgical risk).

Methods

Patients older than 50 years, without comorbidities, who underwent surgical intervention and general anesthesia were included in the study. Patients were randomized to undergo ECG (group A, n=214) or not (group B, n=213) in the preoperative period. The following variables were analyzed: sex, age, ECG, chest x-ray and laboratory tests results, surgical risk, surgery duration, adverse events and in-hospital mortality. The level of significance was set at 5%.

Results

Adverse outcomes were reported in 23 (5.4%) patients, with a significant number of adverse events in male patients (OR=7.91 95%CI 3.3-18.90, p<0.001) and in those undergoing major surgeries (OR=30.02 95%CI 4.01-224.92, p<0.001). No differences were observed between patients who underwent ECG and those who did not (OR=1.59, 95%CI, 0.67-3.75, p=0.289). No significant differences were found in the other variables. In multivariate logistic regression, male sex (OR = 6.49; 95%CI 2.42-17.42, p<0.001) and major surgery (OR=22.62; 95%CI 2.95-173.41, p=0.002) were independent predictors of adverse outcomes, whereas undergoing (or not) ECG (OR=1.09; IC95% 0.41-2.90, p=0.867) remained without statistical significance.

Conclusion

Our findings suggest that preoperative ECG could not predict an increased risk of adverse outcomes in our study population during the hospital phase.

Electrocardiography; Preoperative Care; General Surgery

Variable	ECG

	Without		With		Total		p

	n	%	n	%	n	%
Sex							0,199
Male	30	14.1	40	18.7	70	16.4
Female	183	85.9	174	81.3	357	83.6
Age (years)	57.37±6.16		58.71±7.51		427	100.0	0.044 ^#
Surgical risk (major/minor surgery)							0.225
Low risk	123	57.7	110	51.9	233	54.8
Moderate/high risk	90	42.3	102	48.1	192	45.2
Chest x-ray							0.192
Normal	208	97.7	204	95.3	412	96.5
Abnormal	5	2.3	10	4.7	15	3.5
Laboratory							<0.001
Normal	213	100.0	199	93.0	412	96.5
Abnormal	0	0.0	15	7.0	15	3.5
Surgical risk (ASA)							0.372*
I	212	99.5	210	98.1	422	98.8
II	1	0.5	4	1.9	5	1.2
Time of surgery (hours)	2 (2 – 3)		2 (2 – 4)		427	100.0	0.042 ^$
Mortality							>0.999*
No	212	99.5	212	99.1	424	99.3
Yes	1	0.5	2	0.9	3	0.7
Complications resolved							0.193
No	205	96.2	200	93.5	405	94.8
Yes	8	3.8	14	6.5	22	5.2
Morbimortality							0.289
No	204	95.8	200	93.5	404	94.6
Yes	9	4.2	14	6.5	23	5.4
Total	213	100	214	100	427	100

	Morbimortality

Variable	No		Yes		OR	95%CI		p

	n	%	n	%		Inferior	Superior
Sex								<0.001*
Male	57	81.4	13	18.6	7.91	3.31	18.90
Female	347	97.2	10	2.8	1.00
Age (years)	56 (52 – 62)		57 (55 – 60)		1.01	0.95	1.07	0.754
Surgical risk (major/minor surgery)								<0.001
Low risk	232	99.6	1	0.4	1.00
Moderate/High risk	170	88.5	22	11.5	30.02	4.01	224.92
Electrocardiogram								0.289
No	204	95.8	9	4.2	1.00
Yes	200	93.5	14	6.5	1.59	0.67	3.75
Chest x-ray								>0.999*
Normal	389	94.4	23	5.6	1.00
Abnormal	15	100.0	0	0.0	&
Laboratory								0.190*
Normal	391	94.9	21	5.1	1.00
Abnormal	13	86.7	2	13.3	2.86	0.61	13.52
Surgical risk								>0.999*
I	399	94.5	23	5.5	1.00
II	5	100.0	0	0.0	&
Time of surgery (hours)	2 (2 – 3)		2 (2 – 5)		1.30	1.01	1.67	0.193 ^$
Total	404	94.6	23	5.4

Variable	OR	95%CI		p

		Inferior	Superior
Sex (male)	6.49	2.42	17.42	<0.001
Age (years)	1.00	0.93	1.07	0.943
Major surgery (Moderate/high risk)	22.62	2.95	173.41	0.003
Abnormal laboratory findings	1.39	0.22	8.88	0.726
Time of surgery	1.47	1.09	1.99	0.013
Electrocardiogram performed	1.09	0.41	2.90	0.867

Variable	ECG

	Normal		Abnormal		Without ECG		Total		p

	n	%	n	%	n	%	N	%
Mortality									0.241
No	196	99.5	16	94.1	212	99.5	424	99.3
Yes	1	0.5	1	5.9	1	0.5	3	0.7
Morbidity									0.300
No	185	93.9	15	88.2	205	96.2	405	94.8
Yes	12	6.1	2	11.8	8	3.8	22	5.2
Morbimortality									0.402
No	185	93.9	15	88.2	204	95.8	404	94.6
Yes	12	6.1	2	11.8	9	4.2	23	5.4
Total	197	100	17	100	213	100	427	100

Variable	ECG

	Normal		Abnormal		p

	n	%	n	%
Mortality					0.153
No	196	99.5	16	94.1
Yes	1	0.5	1	5.9
Morbidity					0.307
No	185	93.9	15	88.2
Yes	12	6.1	2	11.8
Morbimortality					0.307
No	185	93.9	15	88.2
Yes	12	6.1	2	11.8
Total	197	100.0	17	100.0

Variables	Sex

	Male		Female		p

	n	%	n	%
ECG					0.104 ^#
Normal	34	48.6	163	45.7
Abnormal	6	8.6	11	3.1
Without ECG	30	42.9	183	51.3
Surgical risk (minor/major surgery)					<0.001
Low risk	24	34.8	209	58.7
Moderate/high risk	45	65.2	147	41.3
Time of surgery (h)	2 (1 – 3)		3 (2 – 3)		0.067 ^&
Chest x-ray
Normal	69	98.6	343	96.1	0.483*
Abnormal	1	1.4	14	3.9
Laboratory					0.081*
Normal	65	92.9	347	97.2
Abnormal	5	7.1	10	2.8
Surgical risk (ASA)					0.593*
I	69	98.6	353	98.9
II	1	1.4	4	1.1
Age (years)	60.9±8.7		57.5±6.3		0.002 ^$
Total	70	100.0	357	100.0

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[1] Mailing Address: Lafayete Ramos • Instituto Brasileiro de Controle do Câncer – Divisão de Cardiologia – Avenida Alcântara Machado, 2576. Postal Code 03102-002, São Paulo, SP – Brazil E-mail: lafayetewilliam@uol.com.br