The role of the routine pre-operative electrocardiogram in the elderly surgical patient

In a group of 222 general surgical patients aged 65 years and over, only 21% had a normal preoperative electrocardiogram (e.c.g.) and 53% had a major pre-operative e.c.g. abnormality. The clinical significance of these findings was evaluated by observing the post-operative cardiovascular complications and e.c.g. changes which occurred. It was concluded that a routine pre-operative e.c.g. should be carried out in all elderly surgical patients (1) as a baseline measurement to aid interpretation of post-operative e.c.g. changes and (2) as a means of detecting patients with acute myocardial infarctions or serious arrhythmias in whom surgery should be deferred. As a method of predicting post-operative cardiovascular complications, however, the pre-operative e.c.g. appears to be of no value in elderly men and of only limited value in elderly women.