Importância prognóstica do eletrocardiograma pré-operatório em pacientes de baixo risco submetidos à intervenção cirúrgica sob anestesia geral

Abstract

Background: Patients aged over 50 years require four times more surgical interventions than younger groups. Many guidelines recommend the performance of preoperative electrocardiogram (ECG) in this population. Objectives: To determine the value of preoperative ECG in patients aged over 50 years and classified as ASA I–II (surgical risk). Methods: Patients older than 50 years, without comorbidities, who underwent surgical intervention and general anesthesia were included in the studied. Patients were randomized to undergo ECG (group A, n=214) or not (group B, n=213) in the preoperative period. The following variables were analyzed: sex, age, ECG, chest x-ray and laboratory tests results, surgical risk, surgery duration, adverse events and in-hospital mortality. The level of significance was set at 5%.Results: Adverse outcomes were reported in 23 (5.4%) patients, with a significant number of adverse events in male patients (OR=7.91 95%CI 3.3-18.90, p<0.001) and in those undergoing major surgeries (OR=30.02 95%CI 4.01-224.92, p<0.001). No differences were observed between patients who underwent ECG and those who did not (OR=1.59, 95%CI, 0.67-3.75, p=0.289). No significant differences were found in the other variables. In multivariate logistic regression, male sex (OR = 6.49; 95%CI 2.42-17.42, p<0.001) and major surgery (OR=22.62; 95%CI 2.95-173.41, p=0.002) were independent predictors of adverse outcomes, whereas undergoing (or not) ECG (OR=1.09; IC95% 0.41-2.90, p=0.867) remained without statistical significance. Conclusion: Our findings suggest that preoperative ECG could not predict an increased risk of adverse outcomes in our study population during the hospital phase.