BACKGROUND: There are conflicting data on the relationship between preoperative electrocardiogram and postoperative mortality. We aimed to assess the predictive value of preoperative ECG on postoperative all-cause mortality in patients undergoing non-cardiac surgery (NCS). METHODS: We retrospectively reviewed records of hospitalized patients who underwent an internal preoperative examination and subsequent NCS in the years 2015-2021. We recorded patient comorbidities, vital functions, results of biochemical tests, ECG. The primary end point was 90-day postoperative all-cause mortality, acquired from the hospital records and the nationwide registry run by the Institute of Health Information and Statistics of the Czech Republic. RESULTS: We enrolled a total of 2219 patients of mean age 63 years (48% women). Of these, 152 (6.8%) died during the 90-day postoperative period. There were statistically significant associations between increased 90-day postoperative all-cause mortality and abnormal ECG findings in resting heart rate (≥ 80 bpm, relative risk [RR] = 1.82 and ≥ 100 bpm, RR = 2.57), presence of atrial fibrillation (RR = 4.51), intraventricular conduction delay (QRS > 0.12 s, RR = 2.57), ST segment changes and T wave alterations, left bundle branch hemiblock (RR = 1.64), and right (RR = 2.04) and left bundle branch block (RR = 4.13), but not abnormal PQ and QT intervals, paced rhythm, incomplete right bundle branch block, or other ECG abnormalities. A resting heart rate (≥ 80 bpm, relative risk [RR] = 1.95 and ≥ 100 bpm, RR = 2.20), atrial fibrillation (RR = 2.10), and right bundle branch block (RR = 2.52) were significantly associated with 90-day postoperative all-cause mortality even in subgroup of patients with pre-existing cardiac comorbidities. CONCLUSIONS: Patients with abnormal preoperative ECG findings face an elevated risk of all-cause mortality within 90 days after surgery. The highest mortality risk is observed in patients with atrial fibrillation and left bundle branch block. Additionally, an elevated heart rate, right bundle branch block, and atrial fibrillation further increase the risk of death in patients with pre-existing cardiac conditions.

Department of Internal Medicine and Cardiology University Hospital Ostrava Ostrava Czech Republic

Department of Internal Medicine Associated Medical Facility Krnov 1 P Pavlova 9 Krnov 794 01 Czech Republic

Faculty of Medicine and Dentistry Palace University Olomouc Olomouc Czech Republic

Faculty of Medicine University of Ostrava Ostrava Czech Republic

Institute of Biostatistics and Analyses Masaryk University Brno Czech Republic

BMC Anesthesiol. 2024 Oct 14;24(1):372. doi: 10.1186/s12871-024-02761-w. PubMed

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Kirkham KR, Wijeysundera DN, Pendrith C, et al. Preoperative testing before low-risk surgical procedures. CMAJ. 2015;187(11):E349–58. 10.1503/cmaj.150174. PubMed PMC

Siriussawakul A, Nimmannit A, Rattana-arpa S, Chatrattanakulchai S, Saengtawan P, Wangdee A. Evaluating compliance with institutional preoperative testing guidelines for minimal-risk patients undergoing elective surgery. Biomed Res Int. 2013;2013:835426. 10.1155/2013/835426. PubMed PMC

Gutiérrez Martínez D, Jiménez-Méndez C, Méndez Hernández R, Hernández-Aceituno A, Planas Roca A, Aguilar Torres RJ. Incidence of electrocardiographic alterations in the preoperative period of non-cardiac surgery. Rev Esp Anestesiol Reanim (Engl Ed). 2021;68(5):252–7. 10.1016/j.redare.2020.11.003. PubMed

Correll DJ, Hepner DL, Chang C, Tsen L, Hevelone ND, Bader AM. Preoperative electrocardiograms: patient factors predictive of abnormalities. Anesthesiology. 2009;110(6):1217–22. 10.1097/ALN.0b013e31819fb139. PubMed

Sowerby RJ, Lantz Powers AG, Ghiculete D, et al. Routine preoperative electrocardiograms in patients at Low Risk for Cardiac complications during Shockwave lithotripsy: are they useful? J Endourol. 2019;33(4):314–8. 10.1089/end.2019.0053. PubMed

Studzińska D, Polok K, Rewerska B, et al. Prognostic value of preoperative electrocardiography in predicting myocardial injury after vascular surgery [published online ahead of print, 2022 Mar 28]. Kardiol Pol. 2022. 10.33963/KP.a2022.0085. PubMed

Dorman T, Breslow MJ, Pronovost PJ, Rock P, Rosenfeld BA. Bundle-branch block as a risk factor in noncardiac surgery. Arch Intern Med. 2000;160(8):1149–52. 10.1001/archinte.160.8.1149. PubMed

Richardson KM, Shen ST, Gupta DK, Wells QS, Ehrenfeld JM, Wanderer JP. Prognostic significance and clinical utility of Intraventricular Conduction Delays on the Preoperative Electrocardiogram. Am J Cardiol. 2018;121(8):997–1003. 10.1016/j.amjcard.2018.01.009. PubMed

Jeger RV, Probst C, Arsenic R, et al. Long-term prognostic value of the preoperative 12-lead electrocardiogram before major noncardiac surgery in coronary artery disease. Am Heart J. 2006;151(2):508–13. 10.1016/j.ahj.2005.04.018. PubMed

Flaherty D, Kim S, Zerillo J, et al. Preoperative QTc interval is not Associated with intraoperative cardiac events or mortality in liver transplantation patients. J Cardiothorac Vasc Anesth. 2019;33(4):961–6. 10.1053/j.jvca.2018.06.002. PubMed

Smith T, Pelpola K, Ball M, Ong A, Myint PK. Pre-operative indicators for mortality following hip fracture surgery: a systematic review and meta-analysis. Age Ageing. 2014;43(4):464–71. 10.1093/ageing/afu065. PubMed

Landesberg G, Einav S, Christopherson R, et al. Perioperative ischemia and cardiac complications in major vascular surgery: importance of the preoperative twelve-lead electrocardiogram. J Vasc Surg. 1997;26(4):570–8. 10.1016/s0741-5214(97)70054-5. PubMed

Ohrlander T, Dencker M, Dias NV, Gottsäter A, Acosta S. Cardiovascular predictors for long-term mortality after EVAR for AAA. Vasc Med. 2011;16(6):422–7. 10.1177/1358863X11425713. PubMed

Roberto Bolognesi D, Tsialtas MG, Bolognesi S, Assimopoulos M, Azzarone, Riccardo Volpi. Perioperative complications following major vascular surgery. Correlations with preoperative cliniclectrocardiographic and echocardiographic features. Acta Biomed. 2022;93(3):e2022255. Published 2022 Jul 1. 10.23750/abm.v93i3.12961 PubMed PMC

Hanci V, Yurtlu S, Aydin M, et al. Preoperative abnormal P and QTc dispersion intervals in patients with metabolic syndrome. Anesth Analg. 2011;112(4):824–7. 10.1213/ANE.0b013e3181f68ff8. PubMed

Prasada S, Desai MY, Saad M, et al. Preoperative Atrial Fibrillation and Cardiovascular outcomes after noncardiac surgery. J Am Coll Cardiol. 2022;79(25):2471–85. 10.1016/j.jacc.2022.04.021. PubMed

Correction: Preoperative electrocardiogram in prediction of 90-day postoperative mortality: retrospective cohort study