3139 Do preoperative ECG abnormality at pre-assessment predict cardiac complications in patients undergoing major non-cardiac surgery

Abstract

Background Cardiovascular complications are one of the most common causes of morbidity and mortality perioperatively during non-cardiac surgery. This risk is significantly increased in those ≥65 and those who are frail. NICE and ESC both recommend that all patients ≥65 have a pre-operative ECG to assess each patient’s risk of perioperative cardiovascular complications before any intermediate or high-risk surgery. This study aims to assess the risk of perioperative cardiovascular complications in those ≥65 with abnormal ECGs. Methods We analysed data from patients attending our combined Geriatrician and Anaesthetist run pre-operative assessment clinic for elective colorectal cancer resections between 23/09/2021–11/09/2023. All patients were aged ≥65, those who then underwent surgery had their pre-operative ECGs assessed for abnormalities including; New AF, LBBB, RBBB, LAD, Heart block, ectopics, ST depression, and T wave Inversion. There were no patients with episodes of non-sustained VT or long QT intervals, two categories ordinarily considered higher risk for complications. The discharge letters, operation notes, and any post-operative cardiology letters were then assessed for any perioperative/post-operative cardiac complications including myocardial infarction, cardiac arrest, acute heart failure, and established new arrhythmias. Results 140 patients between 23/09/2021 and 11/09/2023 underwent elective colorectal resection. 56 of these patients had abnormal pre-operative ECGs (40%) with; New AF (2), LBBB (3), RBBB (16), LAD (15), Heart block (6), Ectopics (7), ST depression (3), and T-wave Inversion (4). On assessment, none of these patients had any perioperative or postoperative cardiac complications. Conclusion Our study suggests pre-operative ECGs alone were not predictive of perioperative/post-operative cardiac complications in patients undergoing elective colorectal resection for cancer. All of the patients were managed by perioperative Geriatricians without the need of further onward referrals to Cardiology, suggesting a perioperative cost saving.