Is an EKG Necessary for Pre-op Rhinoplasty in a 45 Year Old with No Heart Issues?

This is a good question!

As others have said, the institutional policy usually dictates what is required.  According to more recent studies of preoperative studies (like labs, EKG, X-Rays, etc), there is usually very little to gain from doing an EKG in a healthy individual with no cardiac history.  On the other hand, if a patient is diabetic, has a history of heart disease (including immediate family members), any history of chest pain or early exertion or similar warning signs, an EKG or even a more extensive workup may be indicated.

For my location, someone who lacks any risk factors or history and is under 55 does not require any studies prior to surgery.  That being said, I do screen my patients thoroughly for these things by reviewing their history, examining them and interviewing them prior to their big day.

All the best to you!

EKG testing is routine and non-invasive for patients requesting nose job surgery that are over 40. In my practice, blood work is not indicated in otherwise healthy 40-year-olds, unless the "bleeding questionnaire" raises concerns.

Good luck.

Dr. Joseph

It depends on the policy of the  institution or private clinic you are having surgery.  In the past EKG and blood work was ordered routinely before elective surgery. Recently there has been a move towards ordering lab work when it is  clinically indicated.

45 years old is usually the threshold age for which most surgery centers and hospitals will require an EKG prior to any type of elective surgery.  They are simple, easy to perform, and takes about 10 minutes in a doctor’s office to have one done.  This is done out of patient safety.

Being healthy including having no known heart problems is always a good thing when contemplating surgery. However, you usually can't fight the established policy of a health care facility as regards lab work and an EKG. Different institutions have different regulations. Some don't require an EKG until age 50 unless there are known significant underlying medical problems; others use 40 or 45 as the cut-off. Find out from your surgeon what the policy is at the facility where you will be having your surgery.

Most recently all healthcare providers have been asked to look into ways to insure patient safety - and getting EKGs may be some doctors' resonse to safety concerns.

You will be asked repeatedly about your allergies, your medications, and even if you feel adequately informed about the rhinolpasty you have chosen to undergo in any healthcare setting. Office-based surgical suites sometimes don't have the backup support of ancillary staff & equipment that hospital surgicenters have nearby, and may need to be more thorough about looking for heart irregularities.

 

 

 

There will be variation  in tests before surgery depending on where your procedure is performed. In our area, we ask for an EKG at age 50 and above. Also blood tests are not required at all, unless there is a specific health issue or concern.
Best of luck, peterejohnsonmd.com

There is no baseline to when an EKG is mandatory.  In general, an EKG is necessary if...

1. Age >50

2. Diabetes

3. An hx of cardiac disease

4. Strong family hx of cardiac disease

If none of the above are true, I generally do not order a pre-op EKG.  I also ask if the patient can walk a city block without chest pain or shortness of breath.  If that can be done, it tells me that the patient is pretty healthy from a cardiac standpoint.

 

 

As you have found,  every practice is different in their preoperative and postoperative “protocols”. In my practice, an EKG for healthy 45-year-old  patient would not be mandatory. I would suggest that you discuss this concern with your plastic surgeon;  he/she may very well feel comfortable with excluding it from your work up.  If not, assuming you  have done your due diligence in plastic surgeon selection, I would suggest having the EKG done and otherwise complying with your plastic surgeons'  request.

Best wishes.

You are absolutely right. There is no consensus on what should or should not be "included" in a preoperative screening panel. You can thank John Edwards and his buddies in the Personal Injury Industry whose ads cover the back and centers of all Yellow Page books, our roads and highways and intrude on our TV watching with garrish ads for "bad drug" and "bad doctor" solicitation.

Doctors have practiced defensive medicine for years. Unfortunately, the American public does not really care until, as in your case, it VISIBLY hits them in the pocket. The rest of the time it goes along and allows the US to be the ONLY country in the Western Hemisphere without a "Loser Pays" legal tort system.

The surgeon is unlikely to change his practice. He does not financially benefit from it and is only protecting himself. If this precaution a deal breaker for you, you may want to look for a surgeon who does not require such a preop test.