Preoperative EKG for Open Rotator Cuff Surgery
Risk Stratification and Guideline Recommendations
- The American College of Cardiology and American Heart Association recommend that open rotator cuff repair is considered a low-to-intermediate risk noncardiac surgical procedure, not meeting criteria for elevated-risk surgery as defined by current perioperative guidelines 1, 2
- The American College of Cardiology and American Heart Association suggest that for asymptomatic patients undergoing low-risk surgical procedures, routine preoperative resting 12-lead ECG is not recommended to improve outcomes (Class III: No Benefit) 1, 2
- For patients with known coronary heart disease, significant arrhythmia, peripheral arterial disease, cerebrovascular disease, or other significant structural heart disease, a preoperative ECG is reasonable (Class IIa) 1, 2
- The American College of Cardiology and American Heart Association state that active symptoms include chest pain, dyspnea, undiagnosed palpitations, tachycardia, syncope, or murmurs, and a new preoperative ECG is required if any of these symptoms have developed since the prior EKG 1, 2
Critical Decision Points and Supporting Evidence
- The American College of Cardiology and American Heart Association recommend that a repeat EKG can be safely omitted if the patient remains completely asymptomatic from a cardiovascular standpoint, the prior normal EKG was obtained within a reasonable timeframe (6 months is acceptable for stable, asymptomatic patients), and there is no known cardiovascular disease or risk factors requiring monitoring 1, 2
- The 2014 ACC/AHA guidelines suggest that preoperative resting 12-lead ECG is reasonable for patients with known heart disease, peripheral vascular disease, or cerebrovascular disease undergoing intermediate- or high-risk surgery (Class IIa) 3
- The European Society of Cardiology and Institute for Clinical Systems Improvement recommend ECG for patients with cardiovascular risk factors undergoing intermediate- or high-risk surgery 8