718
ORIGINAL42522001005095115161181234281316
ARTICLES75622001004692132152192227269309
Value4253300100437792130165
of60733001003757
electrocardiogram6803300100355086117145170208239275299336352390429453489549
and124533001003471110
chest137133001002967102132159
X-ray15473300100426589124160
examinations172333001003471107167182220255281297336374402
in214233001001452
preoperative22103300100376196136174210234269296312348383
management260933001005994132167205240300336374400
E822822001004183
|351220010018
VNITŘNÍ4268040010746106127172220280301
LÉKAŘSTVÍ748804001074185130188236280325378400
/11948040010731
Vnitř1270804001074693112140166
Lék.1456804001074083122140
2024;70(8):E3-E101615804001074487129169183224266291333355370412457484528567607
/22678040010731
www.casopisvnitrnilekarstvi.cz442680400107651332012142542953293774274464795215705896176436927117307748128548809159449871007102310631101
Discussion4252550013872105157207271323375408470534
This565272001074291110142
study723272001073463110160200
showed939272001073481129194237287
that1242272001072876116143
only1402272001074796114154
a15732720010740
very1630272001074083110152
limited1799272001071937110129156199248
number2064272001074895168218262289
of2369272001074872
patients2457272001075091118137180228255289
that2763272001072775116143
underwent425286001074896145189216284327375402
a8442860010740
non-elective901286001074897145174220239283324354373414457
NCS13752860010757109152
(approximately1544286001072462111161188235273293366407434476495535
220962860010744
out2157286001074896124
of2298286001074872
1000)2386286001074484129175198
required2601286001072669119167185211254304
changes425300001074088129177226270304
in754300001071967
preoperative846300001075077120169219264290332359378419462
management13333000010774115163204253297371415463490
due1848300001074997141
to2014300001072874
abnormal2114300001074090139187214288329348
ECG2487300001074293146
or2658300001074875
CXR27593000010751101146
findings.42531400107244391141159207257289306
This753314001074191110142
finding91731400107234391141159207256
suggested1195314001073481130179223257286329379
that,1595314001072876117144160
for177731400107237198
every1896314001074485128154197
5002115314001074487133
preoperative2269314001075077120169219264290332359378419462
procedures,2752314001075077124425328001074082132180206249282298
only740328001074896115155
19113280010744
patient972328001074991118137180228255
required1244328001072669119166185211254304
a15643280010741
significant1622328001073351100148167191210250292340366
alteration200532800107416087130156198225244291340
in2361328001071967
preoperative2445328001074976119168218262289330357376417460
management.4253420010776118168210261307383429479507524
Therefore,977342001074394140168212237287315359375
in1379342001072069
most14763420010776126161191
patients,1695342001075194122142188237265302319
there2041342001072979125152197
is2266342001071953
little234734200107193968100120166
benefit2540342001075198148194219239269
in2836342001072069
performing425356001075094121147195222296314362411
ECG852356001074293146
and1014356001074189138
CXR11693560010751101146
testing1331356001072870104133151199248
routinely1596356001072673121149168215259279318
prior193135600107507695143170
to2118356001072774
a22083560010741
non-elective2266356001074896144172218237281322352371412455
NCS.27373560010758109152168
Similar565370001074260133152171211237
results824370001072669103150169197232
were10773700010765109135178
reported1276370001072770120169196227269319
in1617370001071966
other1705370001074875123167194
studies1920370001073463111160179223256
on2198370001074896
low-risk2316370001071967132160187207239277
patients2614370001075092119138181230256291
or425384001074875
patients526384001075092119138181230256291
that844384001072776116144
underwent1014384001074896145189216284327376402
an1443384001074089
elective1558384001074363107148178197238282
NCS18663840010757109152
(6-10,204438400107246696134174189
16-17).2259384001074483113151188212226
Our25113840010760109135
results2673384001072669103150169197232
largely42539800107195985132176194234
confirmed675398001074086134157176202275319368
and1059398001074188137
expanded1212398001074382131172220269312361
those1589398001072875123156200
results1805398001072668102148166194228
to2049398001072874
an2139398001074088
unselected2243398001074794127170189232273303345394
patient2653398001074990117135179226252
population.425412001075099149197216257284303351399416
It565426001071949
could642426001074189139160211
be881426001075197
argued1007426001074270120169215266
that1302426001072879121150
a14804260010742
preoperative1551426001075078123174226272300344372393435480
ECG2060426001074395150
or2239426001074877
CXR23454260010752104151
should2524426001073484134184205256
be2808426001075197
performed425440001075095123151199227302347398
to842440001072875
reduce936440001072670121169211254
perioperative1209440001074995122143192242288316358386406448492
complications1719440001074188163213234253294337365384433483517
and2254440001074190140
perioperative2413440001075095123143192243289316359387406448492
and425454001074191143
postoperative5964540010751102137168216268315343386415435478523
mortality.11484540010775125154186229250269299344357
However,15344540010757107174220262307335348
no1911454001074999
randomized2039454001072770120172222298318356401453
controlled2521454001074189140168196245266286332384
trial42546800107285576117137
has587468001074889124
shown735468001073483132198247
that1007468001072877119147
preoperative1179468001074977121171222268295338366385427471
ECGs1675468001074294148183
could1882468001074188137157207
reduce2114468001072670121170211254
postoperative23934680010750100134164212263309336378407426468512
complications425482001074087161211231250291333360380428477511
or954482001074775
mortality.10474820010773122149181222242261289332345
Conversely,1410482001075198147187231258292337357397409
some1837482001073482157201
studies2056482001073463112161181225259
have2333482001074889129173
suggested2524482001073380130180224258288331381
that425496001072876117145
a5884960010740
lack646496001071960101139
of803496001074872
preoperative893496001075077121170220266292334362381423466
CXR13774960010751102147
was15424960010765107140
not1700496001074897125
associated1843496001074074108157198217258286329379
with2240496001076484113161
perioperative2419496001075095122142190240286313355382402443487
complications425510001074088163213234253294336364384433483517
(21-22).963510001072468108132172216240254
In565524001071966
our648524001074795121
study,786524001073362109158198209
the1012524001072875119
absence1148524001074089122166214254296
of1461524001074770
changes1549524001073986127174223266300
in1866524001071865
preoperative1949524001074875117166215260286327354373414456
management24225240010773113160201249293366409457483
was4255380010765106140
largely58353800107196087136180200241
predictable,842538001074977120171190231262303353374418433
with1293538001076585113162
very1473538001074184111155
high1646538001074867117165
sensitivity1829538001073478127160179208227269289317361
and2208538001074089139
a23655380010740
high2423538001074867117165
NPV,26065380010758103150161
based2785538001074992425552001073378128
on571552001074796
age,685552001074090134149
heart852552001074892132159190
rate,106055200107266896139153
and1231552001074189139
CRP.1387552001075196142148
The1553552001074191136
cut-off1707552001073987116141191215243
values1968552001074082101149193227
we22135520010764108
identified2339552001071868112160187207231251295345
could2702552001074087135154204
provide425566001074975122162181229273
reasonable715566001072668108141188236276325345388
tools1120566001072773122141173
for131056600107237097
limiting1424566001071837109127155174221270
unnecessary1711566001074794141185225267301334375401443
preoperative2171566001074976118166216260286327354373413456
testing.2644566001072769102131150197246262
In3187132001071968
a32821320010741
previous3349132001075078122163184233282316
study3691132001073464113163204
on3922132001074897
patients4046132001075092120140185234262297
with4370132001076585114163
hip4560132001074868118
fractures,470513200107245295136167216244287322339
only5071132001074897117158
0.6%5256132001074460105172
of5455132001074873
preoperative3047146001075078122172223269296339367386428473
CXR35481460010751103149
findings372514600107234493143163212262296
resulted4049146001072670105153173202245296
in4373146001071968
a44691460010741
PPCS4538146001074590143187
(24).4753146001072367108131145
Moreover,49261460010770120147191241283327354367
those5321146001072877126161206
findings304716000107244493143163212262296
were33691600010765110137181
consistent3577160001074087137171190223253297346374
with3977160001076585114164
the4167160001072877122
preoperative4316160001075078121171222268296338366386428472
clinical481516000107406079128147188231250
evaluations.5092160001074485128148196238266285334384418435
Our30471740010759107133
data3197174001074888115156
were33701740010763106133175
consistent3562174001073985133166184216245287334361
with3940174001076382110158
the4115174001072775118
data4250174001074888115156
from442317400107235097169
that4609174001072875115142
study,4768174001073362109158197209
but4994174001074996124
we51351740010764106
studied5258174001073362109158176220269
a30471880010741
larger,311318800107196088137182209222
unselected3360188001074896130175196241283314357408
patient3793188001075092120140185234262
population.4080188001074999150200219261289309358407424
We45291880010774117
found4671188001072372121170220
that4916188001072877119147
450881880010744
out5157188001074797126
of5308188001074872
the5406188001072776122
530472020010744
patients3118202001074992120140184233261297
that3442202001072776118146
had3615202001074890140
a37822020010741
PCCS3849202001074598147191
due4066202001074998143
to4235202001072876
CXR43372020010752103149
findings451320200107234493143163211262295
also483520200107416194144
had5005202001074990140
abnormal5172202001074192141190218294335355
findings304721600107244493143163212262296
on3368216001074897
pulmonary3490216001075099119193243292334361405
auscultation3920216001074189123165213233262304332352401450
and4396216001074089140
objective4561216001074899119163206237256298342
or4929216001074775
subjective5029216001073482132152197239270290332376
difficulties5430216001074969304723000107235172112161180208228272306
during3371230001074997124143192242
a36312300010740
preoperative3689230001075077120170220266293335362382423467
clinical417423000107405978126146186228248
evaluation4440230001074384126146193235262282330379
(the483723000107245199144
one4999230001074796141
remaining5158230001072770144185204252272320370
patient3047244001075092120140185234261
had3330244001074890140
inconclusive3492244001071867109156206247267315349368410454
auscultatory3968244001074189123164213233262304332379407451
findings).444124400107234493143163211262295317332
In3187258001071968
some3273258001073382157202
patients,3493258001075092120139184232260295312
a38232580010741
preoperative3882258001075077121171221267294336364383425469
CXR43692580010751103148
may45352580010774115155
impact4708258001071992143185226257
the4983258001072877122
postoperative5123258001074999133163210261306334376304727200107284789133
management31992720010773115164205256300375420469496
(25).3714272001072467112136150
Moreover,38822720010770120147191241282326353366
some4266272001073483158203
authors4488272001074089118167216244279
have4785272001074890130174
suggested4978272001073481131182226261291334385
that5382272001072776118146
the3047286001072877122
inability3194286001071968110160180200219248292
to3511286001072875
compare3611286001074188163213256283327
pre-3963286001075078122152
and4140286001074190140
postoperative43052860010750100135165212263309336379407427468513
CXRs48432860010751103148184
may50522860010774116155
result5233286001072670105153172201
in5460286001071867
different304730000107496893121165193236285313
postoperative33783000010750100134164211262308335377405425467511
management.39073000010773115164205255300374419468496513
In4438300001071968
the4524300001072877122
present4664300001075078121156201250277
study,4960300001073363112162203215
we51943000010764109
could5321300001074087136156206
not3047314001074898126
address3194314001074191142169213247282
this349731400107287797130
issue,364931400107195286134179195
due3865314001074998142
to4029314001072875
the4126314001072877122
lack4269314001071961102141
of4432314001074872
this452631400107287796130
type4677314001072872123169
of4868314001074772
data.4962314001074990118161178
Some3187328001074291165210
previous3416328001074977120162182231279313
studies3747328001073463112162181226260
have4026328001074889129173
suggested4217328001073482132182226261290334384
cut-off4619328001074089118143194218247
values4884328001074083102150195229
for513232800107237199
limiting5249328001071938112132160180228278
the3047342001072877122
number3192342001074896171221267294
of3509342001074873
preoperative3604342001075078121171222268296338366386428472
ECG4098342001074294148
and4269342001074089140
CXR44313420010751103149
tests.4602342001072871106136172189
Cut-off4814342001075198127152204229257
values5093342001074183103152196231
were53473420010765109136180
reported3047356001072770121171199231274325
for3399356001072472100
comorbidities,3526356001074087162212240291311361380409429474508525
ASA4078356001075397149
class,4254356001074060101136170187
respiratory4468356001072670105155175202245273320348392
and4887356001074190140
cardiac5054356001074082110159178219261
signs5342356001073352102151185
and3047370001074190140
symptoms,3207370001073476151202230278353387403
but3630370001075099128
mainly37793700010773115134183203244
age.4043370001074191136152
The4215370001074292138
proposed4373370001074977125176226260306357
cut-off4750370001074088117143194219247
for5017370001072472100
age-based5137370001074191136166218260294339390
ECG3047384001074294148
and3214384001074190140
CXR33733840010751103149
testing3541384001072871106136155204254
ranged3814384001072769118169214265
between4098384001074995124192237282331
404449384001074390
to4558384001072875
654652384001074488
years4759384001074084125152187
(3-4,496538400107246896143159
7-8,5143384001074468114131
18-20).5293384001074484113153197220234
However,30473980010757107173218260304332345
the3420398001072878123
results3572398001072671106154174203239
of3840398001074873
our3941398001074998126
study4095398001073464113164206
showed4329398001073483133199244295
that4652398001072878120148
age4829398001074192137
alone4994398001074162111161207
was52293980010765108143
not5400398001074898127
a30474120010741
good3116412001074999149200
predictor3345412001075078122173193234265313341
of3715412001074873
PCCS,3816412001074598147191208
because4052412001075096139181230264309
it4390412001071948
had4466412001074990141
relatively463541200107277191133161181223268288329
low4992412001072069135
specificity5155412001073484131173193218238280300329373
in3047426001071968
predicting3136426001075078121172192233264284333383
both3541426001074999128177
the3739426001072877122
ECG3883426001074294147
and4052426001074190140
CXR42144260010751102148
findings438442600107234493143163211262295
(see4701426001072457102147
Tables4870426001074278128149193228
751204260010743
and5185426001074190140
8).534742600107446781
As3187440001075287
seen3292440001073378123171
in3481440001071866
the3565440001072876120
results3703440001072669103151170198233
section,3954440001073378119149169217266282
relative425344000107277089130158177218261
risk453244000107264679117
of4667440001074771
90-day4756440001074489119171211250
postoperative5024440001074999132162209259304331372400419460504
all-cause304745400107416079108151193241274319
mortality33844540010773122150181223243262290334
was37364540010764106140
significantly3894454001073352102150170194215255297346373393433
higher4346454001074767116165209236
in4600454001071968
patients4686454001074991119138183231259294
with4998454001076585113162
heart5178454001074893133160192
rate538845400107266896139
above3047468001074090139179222
1003286468001074383128
bpm3432468001074999172
(when3622468001072386134178226
using386546800107488199147196
70-794078468001074385115154196
bpm4291468001074999173
as4481468001074074
a45724680010740
baseline4630468001074990124168187206253297
reference494546800107266993136162205253294336
point).5298468001074998118165192216229
The3047482001074292138
heart3208482001074994135162194
rate342648200107266997140
over3590482001074889133160
1003774482001074484131
bmp39294820010750125175
is4128482001071952
easily4204482001074485119138158198
distinguishable4426482001074969102132152201251299319353401443493514559
during5009482001074997124144193243
clinical527648200107406079128148189231251
examination.3047496001074484126201220269311339358407457474
This3543496001074292112146
suggests3710496001073482132182227262292328
that4060496001072777118146
we42284960010765110
now4359496001074998164
have4545496001074890130174
simply4741496001073453127178198239
acquirable5002496001074182131179199226269319340385
risk540949600107264680118
factor3047510001072467109141189218
of3293510001074874
postoperative33955100010751101136167215266313341384412432475519
mortality39435100010774124153185228248268297341
even4313510001074486131180
before4522510001075097122171199244
we47945100010766111
proceed4933510001075079127170214260312
to5273510001072877
ECG5378510001074395150
testing.3047524001072871106136155204254271
The3340524001074293138
role350052400107277595140
that3662524001072877119147
the3831524001072777122
heart3975524001074893134161193
rate419052400107276997141
should4353524001073382131181200250
play4625524001075071112152
in4799524001071968
preoperative4889524001074977121171222268295338366385427471
management538252400107741163047538001074890140185260305354382
is3450538001071952
discussed3524538001074968102144192226260306356
below.3902538001075096116165230244
Based3187552001074588122167218
on3429552001074898
our3551552001074897124
data,3699552001074991119161178
we39015520010765109
suggest4034552001073482132182227262292
that4350552001072877119147
an4521552001074190
HR46355520010756103
cut-off4762552001074089118143194219247
value5033552001074184103152197
of5254552001074872
>1005351552001075389130176
bpm30475660010751103181
should3257566001073585136186207259
trigger354556600107295879130182229257
preoperative3832566001075079125176229276305349378398442487
ECG4349566001074396152
testing.4530566001072974110141161212264281
This4841566001074395115150
suggestion5021566001073484135187234270301321372423
is5473566001072055
Tab.42560001135093144171
9.62460001135479
Relative73061001074482100145171189227264
risk10126100107264474109
of113961001074568
90-day122561001074284114161206243
postoperative148661001074691121148191237276302344370388426463
all-cause19676100107456482109148193238268305
mortality2290610010772117143171214233251277316
by262461001074581
preoperative27236100107467210815442572001074584110152178196234271
heart71272001074785130156184
rate9137200107256894131
No.138085009854100119
of15168500984571
death16048500984689130159205
(no.13069500982468114133
of14569500984571
pa-tients)15449500984789115143164206253282316339
RR20458500984692
(95%21548500982465108175
CI)2346850098476892
P270585009845
Heart45710700985496138167198
rate6711070098297098140
[bpm]45711700982471119188210
<992108009548
50105710800953978
11511108009539
(14)15681080095215792111
1.2020021080095394990129
(0.18–8.16)21481080095216074108143185226241276311331
0.18926471080095395388123162
50–5996512000953978121159196
51492120009539
(135)15491200095215790128148
0.6219971200095395393131
(0.25–1.56)21451200095216074114154195230240280319339
0.31226471200095395393128162
60–6996213200953979122165203
17147213200953972
(430)15621320095215895134155
0.6620011320095395393133
(0.38–1.17)21521320095215973113152194229239274307329
0.15526491320095395388122158
70–7996714400953976120155193
37147114400953975
(623)15641440095215996136155
Reference208114400954080101140164203246283321
80–8996215600953979122163202
26147015600953977
(430)15651560095215895134155
1.0220001560095394989126
(0.63–1.66)21441560095215973113151192227237277318338
0.94226441560095395391131168
90–9996216800953980123162202
26147216800953977
(310)15671680095215994129150
1.4120021680095394988122
(0.87–2.29)21421680095215973114151188224238278317337
0.16126491680095395388123157
100–10992918000953975116159193229269
20147218000953978
(162)15671800095215792130150
2.0819971800095395393133
(1.24–3.48)21471800095225768108144187223237276317337
0.005263117900984362106151194
110–11993919200953970106149184215249
81508192009539
(63)15651920095215897116
2.1419991920095395388123
(1.04–4.39)21391920095215767107148191232246287324344
0.038263219100984362106149192
120–12993220400953973111154189223262
71507204009539
(26)15642040095215997117
4.5320002040095395393130
(2.24–9.19)21482040095215973114150192232244279313333
<0.001260820300984891110154198239
≥974216009548
130103921600953973112
51511216009539
(19)15682160095215791111
4.4319852160095395392129
(1.96–10.01)21312160095215768105145188223259273312348364
<0.001260821500984891110154198239
RR45622800953978
–548228009540
relative6032280095235672113136152187220
risk;837228009523406698114
CI96522800954359
–1039228009540
confidence109322800953472114134151192226268301334
interval14412280095175881113137173212229
Tab.304760001134989138162
10.3230600011353102125
Relative33786100107437995137161176212246
risk36346100107254168101
of374461001074565
90-day381961001074181108152195229
postoperative405861001074488115139180223259283323346362397432
all-cause44996100107456177102138180223250285
mortality4793610010771113137163203219235259295
by509861001074478
chest518561001073781116145169
X-ray53636100107446690130164
RR44677400984692
(95%45767400982465108175
CI)4768740098476892
P521674009845
X-ray30798600984871100142181
of32778600984571
the33658600982874117
lungs34988600982167113160194
Normal39698700955194119185222239
Reference45038700954080101140164203246283321
Abnormal39279900954791135178203269306323
2.494422990095395392129
(1.83–3.39)4569990095215767108146187224238278316336
<0.00151199800984891110154198239
RR307911100953978
–3171111009540
relative32261110095235672113136152187220
risk;3460111009523406698114
CI358811100954359
–3662111009540
confidence371611100953472114134151192226268301334
interval40641110095175881113137173212229
Heart2924773001035698140168198
rate314077300103286997139
<1408759008542
50146575900853671
01419753008536
1,2513337170085365086122
2,513696810085365086
3,7513336450085365086122
51419610008536
50-5917697590085367293129165
60-6921287590085367293129165
70-7924877590085367293129165
80-8928437590085367293129165
90-9932027590085367293129165
100-109352575900853671107129165201237
110-119388075900853671107129165201237
120-129424375900853672108129165201237
130467275900853672108
Relative1132725147121034689109150178198239281
risk113269514712103274882122
of1132681147121034772
mortality11326721471210371118146176217237257286327
Diagram425592001135985133185222269345
1.797592001135478
Relative903593001074482100145171189227264
risk118359300107264474109
of1309593001074568
90-day1393593001074184113161206243
postoperative1652593001074591121147191237275301344370388426463
all-cause213159300107456482109148192238267305
mortality24525930010771117143171214233251277316
by2784593001074581
preoperative2882593001074571108153199238263306332350388425
heart3323593001074785130156184
rate352359300107266995131