Preoperative Electrocardiographic Findings and Their Impact on Clinical Decision-Making Among Patients Undergoing Cataract Surgery: A Retrospective Audit
Abstract
A retrospective clinical audit evaluating the frequency and types of preoperative ECG findings and their influence on clinical decision-making and patient flow in cataract surgery.
During preoperative evaluation, electrocardiograms are commonly used to identify cardiovascular abnormalities that may influence perioperative care. In outpatient settings, however, the clinical importance of ECG abnormalities and their effect on patient pathways remain uncertain.
To evaluate ECG findings in patients undergoing preoperative assessment and determine their impact on clinical decision-making and patient flow.
Anonymised data from patients undergoing outpatient preoperative assessment for unilateral cataract surgery with intraocular lens insertion between 7 May and 23 July 2024 were examined in a retrospective observational clinical audit. Descriptive statistics, Kruskal-Wallis tests, Fisher’s exact tests and multivariable logistic regression were used.
A total of 247 patients were included. Median age was 76 years (IQR 70–81) and 55% were female. ECGs were classified as normal in 21% (n = 51), borderline in 31% (n = 76), and abnormal in 49% (n = 120). Among abnormal ECGs, conduction abnormalities were most common (53%, n = 64), followed by arrhythmias (32%, n = 39), left ventricular hypertrophy (7%, n = 8), and ischaemic changes (2%, n = 3).
Age (OR 1.04; 95% CI 1.00–1.07; p = 0.034), diabetes mellitus (OR 2.63; 95% CI 1.32–5.41; p = 0.007), and previous cardiac history (OR 3.16; 95% CI 1.62–6.39; p < 0.001) were independently associated with abnormal ECG findings.
Patients were referred for additional anaesthesia review in 89% of cases. Despite the high prevalence of abnormal ECG findings, procedure delays (2.4%), cancellations (1.6%), and overall pathway disruption (2.8%) were uncommon.
Abnormal ECG findings were common among patients undergoing preoperative assessment for cataract surgery, particularly in older patients and those with diabetes or established cardiac disease. However, abnormalities rarely resulted in procedural delay or cancellation, supporting evidence-based ECG utilisation strategies that optimise patient flow while maintaining safety.
Consecutive eligible patient records.
Interquartile range 70–81 years.
120 of 247 ECGs.
Delay and/or cancellation.
49% Abnormal
Of 247 ECGs, 120 were classified as abnormal, 76 as borderline, and 51 as normal.
53% Conduction Abnormalities
Conduction abnormalities accounted for 64 of the 120 abnormal ECG tracings and represented the most frequent abnormal subtype.
32% of Abnormal ECGs
Arrhythmias were identified in 39 patients with abnormal ECG findings.
7% of Abnormal ECGs
Left ventricular hypertrophy was identified in eight patients with abnormal ECG findings.
2% of Abnormal ECGs
Ischaemic changes were identified in three patients with abnormal ECG findings.
89%
The majority of patients were referred for additional anaesthesia review within the preoperative pathway.
2.4%
Only a small proportion of patients experienced a procedural delay despite the high frequency of ECG abnormalities.
1.6%
Procedure cancellation or rescheduling was uncommon within the audited pathway.
2.8%
The composite outcome of delay and/or cancellation occurred in only 2.8% of patients.
OR 1.04 · p = 0.034
Increasing age was independently associated with abnormal preoperative ECG findings.
OR 2.63 · p = 0.007
Patients with diabetes had greater adjusted odds of having an abnormal ECG.
OR 3.16 · p < 0.001
Previous cardiac disease was the strongest independent predictor of an abnormal ECG among the variables included in the regression model.
58% of Cohort
Hypertension was the most common documented comorbidity, affecting 143 of the 247 patients.
19% of Cohort
Diabetes mellitus was documented in 48 patients.
23% of Cohort
A documented history of cardiovascular disease was present in 57 patients.
Risk-Based ECG Utilisation
The findings support evidence-based and selective ECG utilisation strategies that preserve patient safety while reducing unnecessary downstream pathway effects.
Citation Metrics
Citation counts are retrieved independently from scholarly databases. Counts are displayed separately because database coverage, citation matching and update frequency differ between services.
Citations reported through the Crossref scholarly metadata network.
Loading…Citations indexed within the OpenAlex scholarly knowledge graph.
Loading…Citation Generator
Select a referencing style, copy the formatted citation, or export the article record for reference-management software.
PRE-ECG Study
Preoperative ECG Evaluation and Clinical Guidance, examining ECG findings and their impact on patient pathways and clinical decision-making.
Retrospective Observational Clinical Audit
The audit retrospectively examined ECG findings recorded during routine outpatient preoperative assessment and their subsequent influence on clinical decision-making and patient flow.
247 Consecutive Patients
All eligible consecutive patients attending outpatient preoperative assessment during the audit period were included.
Unilateral Cataract Surgery
All patients were scheduled for unilateral cataract surgery with intraocular lens implantation.
7 May – 23 July 2024
The cohort consisted of patients attending outpatient preoperative assessment during this period.
Public Outpatient Preoperative Assessment Service
The audit was undertaken within an outpatient preoperative assessment service in Ireland providing assessment and optimisation for patients scheduled for elective ophthalmic surgery.
Pragmatic Consecutive Sample
The sample consisted of all 247 eligible anonymised patient records during the audit period. A formal sample-size estimate was not required because the project was designed as a retrospective clinical audit rather than an interventional trial.
Preoperative ECG Abnormality
ECG findings were descriptively classified as normal, borderline or abnormal. For multivariable modelling, normal and borderline findings were combined and compared with abnormal ECGs.
Clinical Action & Patient Pathway
Secondary outcomes included clinical actions following ECG review, further investigation, anaesthesia referral, procedure delay, cancellation or rescheduling, and composite pathway disruption.
R / RStudio
Continuous variables were summarised using medians and interquartile ranges and categorical variables using frequencies and percentages. Kruskal-Wallis and Fisher’s exact tests were used for bivariate analyses, with multivariable logistic regression used to identify independent predictors of abnormal ECG findings.
Five Prespecified Predictors
Age, sex, hypertension, diabetes mellitus and previous cardiac history were entered into the multivariable logistic regression model based on clinical relevance and previously published evidence.
Clinical Audit
The PRE-ECG Study was classified as a clinical audit in accordance with institutional policy. Formal research ethics committee approval was therefore not required. Relevant audit and service-evaluation approvals were obtained as required by the institution.
Fully Anonymised Retrospective Data
No direct patient involvement occurred and no identifiable patient information was retained. Data handling followed institutional confidentiality requirements, GDPR and other relevant data-protection requirements.
Collaborative Research Team
AAO: Conceptualization, project oversight,
manuscript preparation;
AMH: Statistical analysis, interpretation,
methodology;
JO: Data management, verification,
quality assurance.
All authors approved the final manuscript.
Conflict of Interest & Funding
Conflict of Interest:
No conflict of interest.
Funding:
No funding received.
Editorial Timeline
Published PDF
The complete peer-reviewed article is available as an
open-access PDF.
Access Full Text PDF ↗
CC BY 4.0
This article is published under the Creative Commons
Attribution 4.0 International licence.
DOI: 10.64573/torgj2606002
Volume 2 · Issue 2 · Special Issue · 2026
The Operating Room Global Journal (TORGJ).
ISSN 3105-3262.
Original Research.
DOI: 10.64573/torgj2606002.
Semantic Scholar
This article has a Semantic Scholar record.
View on Semantic Scholar ↗
Access the Published Article
Read or download the complete peer-reviewed article, access its persistent DOI record, or browse The Operating Room Global Journal.