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

Kód výsledku v 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>

Nalezeny alternativní kódy

RIV/61988987:17110/24:A2503AJH

Výsledek na webu

<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>

Jazyk výsledku

angličtina

Název v původním jazyce

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

Popis výsledku v původním jazyce

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...

Název v anglickém jazyce

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

Popis výsledku anglicky

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...

Druh

J_SC - Článek v periodiku v databázi SCOPUS

CEP obor

—

OECD FORD obor

30218 - General and internal medicine

Projekt

—

Návaznosti

V - Vyzkumna aktivita podporovana z jinych verejnych zdroju

Rok uplatnění

2024

Kód důvěrnosti údajů

S - Úplné a pravdivé údaje o projektu nepodléhají ochraně podle zvláštních právních předpisů

Název periodika

Vnitřní lékařství

ISSN

0042-773X

e-ISSN

1801-7592

Svazek periodika

70

Číslo periodika v rámci svazku

8

Stát vydavatele periodika

CZ - Česká republika

Počet stran výsledku

1

Strana od-do

e3-e10

Kód UT WoS článku

—

EID výsledku v databázi Scopus

2-s2.0-85213352396