preop ekg

[thegasman]

Just curious - we are looking at our routine preop testing guidelines. Who are you guys getting routine ekgs on, and what time period preop is acceptable? Patients have been complaining about unnecessary charges (we have been requiring them within 30 days preop which seems a little stringent). Looking at changing to within 3 or 6 months (especially if nl and unchanged). I understand ekg is a minor clinical predictor, and probably not routinely necessary at all for minor surgery, but I am interested in hearing what everybody else is doing. thanks.

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[cchoukal]

At our pre-op clinic, we tout the ACC guidelines for EKG, which basically justify getting EKGs on almost nobody. The only class I indication is for people getting vascular surgery who already have 1 "clinical predictor." But while we say that we use the guidelines, 9 times out of 10, when you read the guidelines to the clinic attending, they say, "yeah, but we should have a baseline," or "Sure, but the day of surgery attending will want one." or some other excuse.

We don't have a firm timeline on how recent it has to be, but I agree 1 month sounds a little tight. I know we've routinely accepted EKGs nearly a year old...

 

[Noyac]

Every pt is different and that make it hard to put strict guidelines on this subject. I will go with an ECG thats even a year old as long as there haven't been any changes in the pts cardiac status. 6 months is pretty reasonable, IMO. I also disagree with strict age guidelines but where I practice people are pretty healthy even into their 70's. In the southeast it is likely that you will need ECG's in younger pts.

 

[2ndyear]

We have age guidelines, 50 for males, 40 for females. Fairly useless I'd say. As for timeline we don't have a strict cutoff. Patient dependent. Our surgeons are responsible for ordering preop tests, and we still have more than a few that order routing CXR's for just about everything. Very very low yield.

 

[proman]

Shouldn't it be 40 for men and 50 for women? I think that's what we follow.

 

[Licoricestick]

Shouldn't it be 40 for men and 50 for women? I think that's what we follow.

We do follow this, but the main focus is actually risk factor based. So my experience is that my consultants (read attendings if you work in the US) would rather a 40 yo woman with hypertension or a five year history of T2DM got an ECG than a healthy 50 yo man got one.

 

[proman]

What if they are both healthy, and the only thing that is different is gender?

 

[Bertelman]

We have age guidelines, 50 for males, 40 for females. Fairly useless I'd say. As for timeline we don't have a strict cutoff. Patient dependent. Our surgeons are responsible for ordering preop tests, and we still have more than a few that order routing CXR's for just about everything. Very very low yield.

So if he shows up in a couple years, you'll expect to see an ECG?

 

[2ndyear]

Shouldn't it be 40 for men and 50 for women? I think that's what we follow.

You are correct, my bad.