Preoperative EKG for Healthy Elective Cosmetic Surgery Patients

Evidence-Based Recommendations

• The American College of Cardiology/American Heart Association (ACC/AHA) guidelines explicitly state that routine preoperative EKG is not indicated for asymptomatic patients undergoing low-risk surgery, which includes most cosmetic procedures 1, 3
• The European Society of Cardiology and European Society of Anaesthesiology concur that EKG is not indicated for patients with no risk factors who are undergoing low-risk surgery 1
• The Institute for Clinical Systems Improvement recommends against EKG for asymptomatic patients undergoing low-risk surgery unless medical assessment reveals a high-risk patient 2

Clinical Decision Algorithm

• If patient has NO cardiovascular risk factors AND good exercise tolerance, no EKG is needed 1, 2
• If patient has cardiovascular risk factors, consider EKG 1

Special Considerations

• If the patient has a history of cardiovascular disease, peripheral vascular disease, cerebrovascular disease, or significant risk factors, an EKG would be appropriate 1, 3
• For patients with limited or unknown functional capacity, clinical judgment should determine if EKG testing would impact perioperative management 3
• A patient with good exercise tolerance has demonstrated adequate cardiovascular reserve, making additional testing less valuable 3
• Ordering "routine" EKGs without clinical indication increases healthcare costs without improving outcomes 1, 2, 4