ORIGINAL ARTICLES Value of electrocardiogram and chest X-ray examinations in preoperative management | E5 / Vnitř Lék. 2024;70(8):E3-E10 / VNITŘNÍ LÉKAŘSTVÍ www.casopisvnitrnilekarstvi.cz pressure, detailed descriptions of the ECG and CXR, changes in preoperative management, complications after surgery, and mortality. Study goals The primary goal of this analysis was to determine whether an ECG or CXR, acquired prior to non-elective NCS in hospitalized patients, had any impact on changes in preoperative management. We defined a change in a preoperative management as a postponed or completely canceled surgery (PCCS). We also recorded any relevant changes in preoperative medications, such as adjustments in beta-blocker doses or anti-arrhythmic therapy. Sometimes, additional tests were initiated, based on an abnormal ECG or CXR, which turned out to be unnecessary and did not provide any additional information. Therefore, those tests did not actually change the preoperative management. In those cases, we did not record a change in preoperative management; on the contrary, we recorded these as pointless time delays. The secondary goal was to identify potential predictors of a change in preoperative management, due to ECG or CXR findings. We aimed to suggest some cut-off values of the identified predictors, which could be used to reduce the number of unnecessary procedures. Study oversight The study was conducted in accordance with Good Clinical Practice guidelines, and it was approved by the local Ethics Committee. Given the retrospective study design, patients did not provide informed consent before study entry. All the authors involved had access to all patient data and the results of statistical analyses. All the authors agreed to vouch for the accuracy and completeness of the analyzed data. Statistical analysis Standard descriptive statistics were applied in the analysis. Continuous variables are expressed as the mean ±SD or the median and interquartile range. Categorical variables are expressed as absolute and relative frequencies. Differences between patients with and without PCCS were analyzed with the Mann-Whitney test, for continuous variables, and Fisher’s exact test, for categorical variables. Parameters were selected for their abilities to predict PCCS; this was evaluated with a receiver operating characteristic (ROC) analysis and described with the area under the curve (AUC), its confidence interval (CI), and statistical significance (p-value <0.05). The optimal cut-off values were determined by maximization of the Youden index. The analysis was performed in SPSS 28. 0. 1.1 (IBM Corporation, Armonk, NY, USA, 2021). Results We enrolled a total of 2362 patients scheduled for NCS that underwent an internal preoperative examination between September 2015 and November 2021. All patients were included in the primary analysis. Their mean age was 63.4 years, and 48% were women. Among these patients, 56.4% had a history of arterial hypertension, 22.8% had a history of diabetes, and 16.5% had a history of chronic coronary syndrome. The mean heart rate was 79 beats per minute (bpm); the median serum C-reactive protein (CRP) level was 8 mg/l. The clinical and other characteristics of the patients are provided in Table 1. Prior to surgery, only 6 patients did not undergo ECG testing, and 86 patients did not undergo CXR testing. Among these patients, 72% had an abnormal ECG and 33% had an abnormal finding on a CXR. Characteristics of the physiological ECGs and abnormal CXRs used in this study are described in Tables 2 and 3. A PCCS due to a pathological ECG or CXR finding occurred in 4 (0.17%) and 5 (0.21%) patients, respectively, in the entire group. Supraventricular tachyarrhythmia (SVT) was the only reason for a change in preoperative management due to the ECG findings. Pneumonia was the only reason for a PCCS due to CXR findings. Tab. 1. Patient clinical and other characteristics Parameter Category Value Age, y 63 (±15) Sex Men 1.227 (51.9) Women 1.135 (48.1) Hypertension No 1.030 (43.6) Yes 1.332 (56.4) Dyslipidemia No 1.758 (74.4) Yes 604 (25.6) Atherosclerosis No 2.091 (88.5) Yes 271 (11.5) Chronic coronary syndrome No 1.972 (83.5) Yes 390 (16.5) Chronic heart failure No 2.299 (97.3) Yes 63 (2.7) Chronic kidney disease No 2.222 (94.1) Yes 140 (5.9) Ischemic or hemorrhagic stroke No 2.157 (91.3) Yes 205 (8.7) Atrial fibrillation No 2.169 (91.8) Yes 193 (8.2) Diabetes mellitus No 1.824 (77.2) Yes 538 (22.8) Pulmonary disease No 2.053 (86.9) COPD 133 (5.6) AB 100 (4.2) ACOS 14 (0.6) Other 62 (2.6) Oncological disease, malignancy No 2.026 (85.8) Yes 336 (14.2) BMI, kg/m2 28 (± 6) Smoking Non-smoker 1.381 (58.5) Smoker 702 (29.7) Ex-smoker 279 (11.8) Potassium, mmol/l 4.24 (±0.48) CRP, mg/l 8 (3–43) Systolic blood pressure, mmHg 139 (±21) Diastolic blood pressure, mmHg 80 (±12) Heart rate, beats/min 79 (±16) Values are the mean (± standard deviation), number (%), or median (intraquartile range), as indicat-ed. COPD – chronic obstructive pulmonary disease; AB – bronchial asthma; ACOS – asthma-COPD overlap syndrome; CRP – C-reactive protein
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