Discontinuing routine preoperative electrocardiogram testing in low-risk cataract surgery patients: the EliminECG quality improvement project

Introduction: The routine use of preoperative electrocardiograms (ECGs) in patients scheduled for cataract surgery is a deeply entrenched practice in Singapore, despite a lack of evidence supporting its role. Unnecessary ECGs and downstream referrals result in increased healthcare costs, strain on healthcare resources and poorer patient experience from multiple hospital visits, investigations and operation delays. International guidelines recommend against routine use of preoperative ECGs. We launched a quality improvement project to reduce the routine use of preoperative ECGs in low-risk patients undergoing cataract surgery, with the aim of aligning our practice with international guidelines and assessing the impact of this on the incidence of surgical cancellations, perioperative morbidity, and mortality. Methods: One thousand patients scheduled for elective cataract surgery were assigned to either a control group, where routine ECG is performed (current practice) or an intervention group where the need for ECG was determined through standardised screening of relevant symptoms and vitals as per international guidelines. Adverse medical events and surgery postponement were recorded. Results: There was no statistically significant difference in overall cancellation rates between the control and intervention groups (4% vs. 3.2%, P = 0.79). There were no significant differences in the rate of intraoperative events or unplanned admissions between the control and intervention arms. Conclusion: The results of this project indicate no benefit from the current practice of routine preoperative ECG for cataract surgery in asymptomatic individuals. The study also provides local data to support international guidelines which recommend against this routine practice.