Value of electrocardiogram and chest X-ray examinations in preoperative management
The result's identifiers
Result code in IS VaVaI
<a href="https://www.isvavai.cz/riv?ss=detail&h=RIV%2F00843989%3A_____%2F24%3AE0111300" target="_blank" >RIV/00843989:_____/24:E0111300 - isvavai.cz</a>
Alternative codes found
RIV/61988987:17110/24:A2503AJH
Result on the web
<a href="https://casopisvnitrnilekarstvi.cz/pdfs/vnl/2024/08/10.pdf" target="_blank" >https://casopisvnitrnilekarstvi.cz/pdfs/vnl/2024/08/10.pdf</a>
DOI - Digital Object Identifier
<a href="http://dx.doi.org/10.36290/vnl.2024.103" target="_blank" >10.36290/vnl.2024.103</a>
Alternative languages
Result language
angličtina
Original language name
Value of electrocardiogram and chest X-ray examinations in preoperative management
Original language description
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 ident...
Czech name
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Czech description
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Classification
Type
J<sub>SC</sub> - Article in a specialist periodical, which is included in the SCOPUS database
CEP classification
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OECD FORD branch
30218 - General and internal medicine
Result continuities
Project
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Continuities
V - Vyzkumna aktivita podporovana z jinych verejnych zdroju
Others
Publication year
2024
Confidentiality
S - Úplné a pravdivé údaje o projektu nepodléhají ochraně podle zvláštních právních předpisů
Data specific for result type
Name of the periodical
Vnitřní lékařství
ISSN
0042-773X
e-ISSN
1801-7592
Volume of the periodical
70
Issue of the periodical within the volume
8
Country of publishing house
CZ - CZECH REPUBLIC
Number of pages
1
Pages from-to
e3-e10
UT code for WoS article
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EID of the result in the Scopus database
2-s2.0-85213352396