The Impact of Preoperative abnormal Electrocardiography on Anesthesia management among older surgical patients in southern Ethiopia: Prospective cohort study

Background

Due to their advanced age and the prevalence of numerous co-morbid conditions, elderly patients scheduled for surgery are at risk for preoperative ECG abnormalities. Although preoperative ECG is frequently used to identify cardiovascular diseases and reduce intraoperative morbidity and mortality, its impact in predicting perioperative cardiovascular complications is under debate.

Objective

The aim of this study was to determine the impact of preoperative abnormal ECG on anesthesia management among older surgical patients in southern Ethiopia, 2022.

Method

ology: A multicenter prospective observational study on 246 elderly surgical patients recruited consecutively was conducted at three teaching hospitals in southern Ethiopia. Data were entered into Epidata version 4.6, then exported and analyzed in STATA version 16. The data was presented in the appropriate manner, using numbers, frequencies, tables, charts, and figures. To test categorical variables, the Chi-square test was used. P-values of 0.05 were considered statistically significant.

Result

In this study, 120 (48.78%) of older surgical patients had abnormal preoperative ECGs. In terms of severity, 55.3% were classified as minor, while 44.16% were major ECG abnormalities. 26 (21.66%) of patients with abnormal ECG were decided as unfit for anesthesia and reasons for the decision were the need for further investigation, consultation, and optimization. In addition, 7.31% of patients were delayed due to an abnormal ECG with a mean operative delay of 4.23 days. Preoperative abnormal ECG influenced the decision of anesthesia plan in four (1.62%) of the cases. Patients with an abnormal ECG prior to surgery were more likely to experience an intraoperative arrhythmia (p-value = 0.001).

Conclusion

and recommendation: Almost half (48.78%) of elderly patients presenting for surgery have an abnormal ECG, which impacts patients by postponing surgery and necessitating further investigation. Preoperative ECG is recommended prior to any elective surgery as early as 50 years, especially for those with risk factors.