Evaluation of the efficacy of routine preoperative electrocardiograms.
OBJECTIVE
To evaluate the efficacy of routine preoperative electrocardiograms (ECG) in predicting perioperative cardiovascular complications in an essentially healthy population.


METHODS
Retrospective chart review.


METHODS
The adult hospital of a large academic medical center.


METHODS
One thousand ASA class I and II adult patients undergoing a number of different elective surgical procedures.


METHODS
None.


RESULTS
The mean age of the population was 48 years (range, 18 to 88), and 53% were female. Fifty-seven percent of the population had a preoperative ECG, of which 56.5% were considered normal, 37.8% were abnormal, and 6.6% were considered borderline. Twenty-seven percent of the population presented with cardiovascular risk factors, and of these, 93.2% had an ECG performed. Seventy-three percent of patients had no cardiovascular risk factors, and of these, 44.5% had a preoperative ECG. Patients who had cardiovascular risk factors had significantly more abnormal ECGs than those without (51% v 26.1%,); however, there was no difference in the prevalence of perioperative events between the two groups. The positive predictive value of an abnormal ECG for a perioperative event was slightly greater for patients with cardiovascular risk factors than for those without (42.7% v 34.7%, respectively); however, this difference was not significant. In addition, a normal ECG was just as predictive as an abnormal one.


CONCLUSIONS
Results of this study suggest that the practice of routine ECG screening for patients with no cardiovascular risk factors is a poor predictor of perioperative complications in this patient population. A review of the current criteria for ordering preoperative ECGs may reduce the number of unnecessary tests and improve cost-effectiveness.
Tait
A R
AR
Department of Anesthesiology, University of Michigan Medical Center, Ann Arbor 48109, USA.
Parr
H G
HG
Tremper
K K
KK
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000517:prevention & control; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies