Utility of Preoperative Electrocardiograms Prior to Urogynecologic Surgery

Objectives: According to a study published in Obstetrics & Gynecology in 2010, 29% of patients undergoing gynecologic surgery had an abnormal preoperative ECG, yet only 12% had further evaluation. Moreover, there are sparse data about the impact of age on abnormal preoperative ECG for urogynecologic surgery. The aim of our study is to determine whether there is an association between age and abnormal ECG in patients undergoing urogynecologic surgery, and whether abnormal ECGs are associated with delays/cancellations in surgery, additional pre-operative testing, or cardiac adverse events post-operatively.

Methods: This is a single-site retrospective cohort study of patients who had preoperative visits for urogynecologic surgery between August 2021 to June 2022. The primary outcome was the frequency of abnormal ECG in patients < 65 years old vs patients 65 years old and greater. The secondary outcomes were the effect of abnormal ECG based on age group and delay/cancellation in surgery due to cardiac reasons and composite cardiac morbidity within 90 days (arrhythmia, myocardial infarction, venous thromboembolism, cerebrovascular accident, readmission, and respiratory failure). We queried our electronic medical record to identify all patients seen for Urogynecology preoperative visits within the time frame. Demographic data were collected and preoperative ECGs were reviewed. Statistical analysis was performed with SPSS. Chi square tests were performed to analyze the frequency of abnormal ECG in the different age groups, and the effect of abnormal ECG in the age groups on the secondary outcomes.

Results: There were 302 patients who had preoperative visits for urogynecologic surgery August 2021 to June 2022. Patient demographics are shown in Table 1. ECGs were ordered for 238 patients (79%), and 130 ECGs were abnormal (54.6%), with t wave changes being the most common abnormality. The number of abnormal ECG in patients < 65 years old (n=52, 57.8%) and 65 years old and greater (n=78, 54.2%) were not statistically different (X=0.29, p=0.59). Abnormal ECGs in patients 65 years or older were not associated with an increase in composite cardiac morbidity (X=1.27, p=0.26) or surgical delay/cancellations due to cardiac reasons (X=0.03, p=0.87) when compared to abnormal ECGs in patients < 65 years old.

Conclusions: The frequency of abnormal ECG in patients < 65 years old and 65 years old and greater were not statistically different. However, the percentage of abnormal ECG in our patient population was much higher than documented literature in the general gynecology population. This could be due to urogynecologic patients being generally older with more comorbidities. Abnormal preoperative ECGs were not associated with delay or cancellation in surgeries for further work-up or composite cardiac postoperative morbidity for urogynecologic procedures. However, this study was not sufficiently powered to see a difference in these outcomes and further research is needed to recommend a change in clinical practice.