• Chun-Ning Ho, Wei-Chu Chung, Chia-Li Kao, Chih-Wei Hsu, Kuo-Chuan Hung, Chia-Hung Yu, Jen-Yin Chen, and I-Wen Chen.
• School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung City, Taiwan; Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan.
• J Clin Anesth. 2024 Nov 1; 98: 111574111574.

Study ObjectiveAlthough a prolonged heart rate-corrected QT interval (QTcI) is associated with an increased risk of mortality in the general population, its prognostic value in surgical patients remains unclear. We aimed to examine whether preoperative QTcI prolongation predicts short-term postoperative outcomes in elderly patients undergoing noncardiac surgery.DesignThe study was a retrospective analysis using the TriNetX network database.SettingOperating room.InterventionAssessment and categorization of preoperative QTcI.PatientsData of patients aged ≥65 years who underwent non-cardiac surgery between 2010 and 2023 were analyzed.MeasurementsPatients were categorized into four groups based on preoperative QTcI: long (500-600 ms), borderline (460-500 ms), high-normal (420-460 ms) and control (370-420 ms) groups. The groups were compared using a propensity score-matched analysis. The primary outcome was the all-cause 90-day mortality risk. The secondary outcomes included 90-day risks of postoperative new-onset atrial fibrillation (Af), ventricular arrhythmias (VAs), emergency visits, hospital readmissions, and pneumonia.ResultsIn total, data on 519,929 patients were collected in this study. Pairwise comparisons showed that all QTcI prolongation groups demonstrated a heightened incidence of postoperative mortality, arrhythmias, and other complications compared to the control group. Patients with a long QTcI had a 3-fold higher risk of mortality (hazard ratio [HR] = 3.124, p < 0.001), Af (HR = 3.059, p < 0.001), and VAs (HR = 3.617, p < 0.001) than controls. The risks of emergency visits (HR = 1.287, p < 0.001), hospital readmissions (HR = 1.591, p < 0.001), and pneumonia (HR = 1.672, p < 0.001) were also higher in the long QTcI group than in the control group. A dose-dependent response was evident between QTcI and mortality as well as arrhythmia risk.ConclusionPreoperative QTcI screening effectively risk-stratifies elderly surgical patients, with a QTcI≥500 ms being strongly predictive of short-term postoperative mortality and other complications. Incorporating QTcI assessment into the preoperative evaluation may guide perioperative monitoring and management.Copyright © 2024 Elsevier Inc. All rights reserved.

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