Preoperative ECG Abnormalities Among Patients Who Underwent Elective Surgical Operations at the Kuwaiti Specialised Hospital, Khartoum, Sudan: A Cross-Sectional Study

Abstract

Background: The presence of preoperative ECG abnormalities has shown wide variation, and its value has been argued; thus, this study aimed to determine preoperative ECG abnormalities among Sudanese patients and their correlates.

Materials and methods: An observational descriptive cross-sectional study was conducted at the Kuwaiti Specialised Hospital, Khartoum, Sudan, from October 2020 to March 2021, including all patients over 40 years of age who planned to undergo elective surgery. Demographic, clinical, and ECG findings were obtained during the pre-anaesthesia check-up. The data were analysed using IBM SPSS software version 28 (IBM Corp., Armonk, NY).

Results: The study included a total of 304 patients with a mean age of 60±14 years, a male predominance of 210 (69.1%) patients, the presence of hypertension (HTN) in 65 (21.4%), and diabetes mellitus (DM) in 58 (19.1%) patients. The study showed that 235 (77%) patients had at least one ECG abnormality. However, 62 (20.4%) were diagnosed as having normal ECG variations; the most commonly diagnosed abnormality was ischemic heart disease (IHD) (32.5%), followed by sinus tachycardia (39, 12.8%). The QRS complex abnormalities were the most common (100, 32.9%), with M-shaped QRS (RSR pattern) being the most common single ECG abnormal sign (65, 21.4%). The ECG abnormalities showed no significant association with age (p-value = 0.24), gender (p-value = 0.16), DM (p-value = 0.77), HTN (p-value = 0.35), asthma (p-value = 0.35), or the grade of surgery (p-value = 0.52). However, the diagnosis of IHD was associated with the presence of HTN (p-value = 0.001).

Conclusion: Incidental preoperative ECG abnormalities are common among Sudanese patients undergoing elective surgery, affecting more than three-quarters of them and being of diagnostic value as they led to the diagnosis of ischemic heart disease in nearly one-third of patients. Hypertensive patients may benefit from routine preoperative ECG testing, as ECG signs of ischemic heart disease are more common among hypertensive patients.

Keywords: abnormal ecg; elective surgeries; pre-operative evaluation; preoperative evaluation; qrs abnormalities; rsr pattern.

Figure 1. The diagnoses of ECG abnormalities (n = 304)

Multiple diagnoses are possible. IHD: ischemic heart disease; ECG: electrocardiogram; RVH: right ventricular hypertrophy; RBBB: right bundle branch block; PVCs: premature ventricular contractions