EKG is Not Needed for Preoperative Testing in Cataract Surgery
Patients in their usual state of health undergoing cataract surgery do not require preoperative EKG testing, regardless of age or the presence of cardiovascular risk factors, because cataract surgery is classified as low-risk and routine testing does not improve outcomes. 1, 2
Evidence-Based Rationale
Cataract Surgery as Low-Risk Procedure
Cataract surgery is explicitly classified as a low-risk surgical procedure by the American College of Cardiology and American Heart Association, and routine preoperative EKG testing is not recommended regardless of patient characteristics. 2
A landmark randomized controlled trial of over 19,000 patients undergoing cataract surgery found no difference in outcomes between those who received routine preoperative testing (including EKG) versus no testing, and abnormal preoperative test results did not predict adverse outcomes. 1
This finding was reinforced by a 2012 Cochrane review confirming that routine preoperative testing provides no benefit in cataract surgery patients. 1
Guideline Consensus Across Multiple Societies
The American College of Cardiology/American Heart Association guidelines state that EKG is not indicated for asymptomatic patients undergoing low-risk surgery. 1
The European Society of Cardiology and European Society of Anaesthesiology concur that EKG is not indicated for patients with no risk factors 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. 1
When EKG Should NOT Be Ordered
Do not order routine EKGs based solely on age (even if >65 years), as this recommendation applies to intermediate- and high-risk surgeries, not cataract surgery. 3
Do not order EKGs based on the presence of cardiovascular risk factors alone (hypertension, diabetes, hyperlipidemia) in asymptomatic patients undergoing cataract surgery. 2
Do not reflexively order EKGs based on laboratory abnormalities (such as elevated creatinine) without considering the surgical risk category, as this increases healthcare costs without improving outcomes. 2
Rare Exceptions: When EKG May Be Indicated
EKG should only be obtained if the patient develops new cardiac symptoms (syncope, new dyspnea, change in angina pattern, palpitations, extreme fatigue) between the time of surgical scheduling and the day of surgery. 3
EKG may be warranted if the patient has active cardiac conditions that would require treatment before any surgery can proceed safely (decompensated heart failure, significant arrhythmias). 3
If the patient requires cardiac evaluation for another medical reason unrelated to surgical clearance, an EKG may be appropriate, but this is not driven by the cataract surgery itself. 4
Common Pitfalls to Avoid
Avoid ordering "routine" EKGs without clinical indication, as this practice increases healthcare costs substantially without improving patient outcomes. 3, 5
Do not confuse guidelines for intermediate- or high-risk surgeries with those for cataract surgery—the risk stratification is fundamentally different. 1
Recognize that even when hypertensive episodes occur perioperatively in cataract surgery patients, they are not associated with adverse medical or surgical outcomes and do not justify preoperative EKG screening. 6
Cost and Resource Considerations
Although individual tests are not expensive, the aggregate cost of unnecessary preoperative testing is substantial, and physicians should act as good stewards of the medical system by using tests judiciously. 4
Routine preoperative evaluation for cataract surgery adds enormous cost and patient burden without demonstrable value. 7