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The pre-operative ECG in day surgery: a habit?
C J Murdoch1, D R Murdoch, P McIntyre
1Specialist Registrar in Anaesthesia; Department of Anaesthetics, Glasgow Royal Infirmary NHS Trust, 82-84 Castle Street, Glasgow G4 0SF, UK.
Anaesthesia
|August 25, 1999
Summary
Pre-operative electrocardiograms (ECGs) have limited value in assessing risk for day-case surgery patients. While abnormalities are found, they rarely impact surgical decisions or lead to adverse events.
Area of Science:
- Anesthesiology
- Cardiology
- Perioperative Medicine
Background:
- Increasing volume of day-case surgery necessitates efficient pre-operative assessment.
- Electrocardiograms (ECGs) are commonly used but their utility in this setting is not well-established.
Purpose of the Study:
- To evaluate the diagnostic and clinical value of resting electrocardiograms in the pre-operative assessment of patients undergoing day-case surgery.
Main Methods:
- A prospective study of 1185 patients undergoing day-case surgery.
- ECGs were performed based on established criteria for coronary artery disease prediction.
- ECGs were independently interpreted by the attending anesthesiologist and a cardiologist.
Main Results:
- 13% of patients (154) were referred for ECGs, with hypertension being a common referral reason.
- Significant abnormalities were detected in 26% of ECGs.
- There was good inter-observer agreement between anesthesiologist and cardiologist interpretations.
- Only 20% of patients with abnormal ECGs had surgery postponed, and no adverse events were reported.
Conclusions:
- Resting electrocardiograms provide limited benefit for risk stratification in the context of day-case surgery.
- Current ECG referral criteria may lead to unnecessary investigations without significantly altering patient management or outcomes.