Utilisation of the pre‐operative ECG

Abstract

The utilisation of the pre-operative ECG inpatients undergoing routine surgery was investigated in 354 adult patients over a 2-week period. Sixty-four percent of patients had an ECG pre-operatively. An ECG was not performed in 17% of patients who, current hospital policy suggests, should have had one. In contrast, an ECG was performed in 33% ofpatients who, hospital policy suggests, have no need of one (all of which were normal), which represented 18% of the total number of pre-operative ECGs performed.In 62% of patients with known cardiac disease, and 44% of patients with strong risk factors for ischaemic heart disease (in the absence of known disease) the ECG was abnormal. This compares with only 7% of patients aged over 50 with no risk factors in whom the ECG was abnormal. These findings suggest that there is room for improvement in the utilisation of the pre-operative ECG, which may have cost implications. Key wordsMonitoring; electrocardiography.The pre-operative ECG is a quick, safe test performed routinely in patients with the aim of detecting pre-existing cardiovascular disease, which, if abnormal is associated with increased postoperative risk [I, 21. It may also be of value as a baseline reading in patients with known cardiac disease or cardiac risk factors to assess the significance of any postoperative ECG abnormalities. However, the accumulated cost of the test is high and, particularly in the present atmosphere of cost containment, the use of such tests needs to be reviewed frequently to ensure that they are being used in appropriate patients.Current guidelines within our hospital suggest that a pre-operative ECG should be performed in all patients who have either known cardiac disease, are at risk of cardiac disease, or who are aged over 50 years.As part of a larger survey of the pre-operative cardiovascular status of the surgical population in our hospital, we have investigated the practice of requesting pre-operative ECGs and the incidence of abnormalities. MethodsThe survey was conducted over a 2-week period in May 1993 in all patients aged over 16 years undergoing anaesthesia in the following specialties: general surgery, urology, ophthalmic surgery, ENT surgery, neurosurgery, dental surgery and vascular surgery. Patients having emergency surgery were not included.Information was collected about each patient presenting for surgery. A careful pre-operative medical history, with particular emphasis on the cardiovascular system, was taken from each patient. Patients with known cardiac disease were defined as patients with ischaemic heart disease (previous myocardial infarction or angina) or valvular heart disease. Patients considered to be at risk of ischaemic heart disease were patients who had hypertension, peripheral vascular disease, diabetes, or a past history of cardiac failure or cerebrovascular event in the absence of known cardiac disease.Patients were divided into four groups based upon their pre-operative history: group 1 = patients with known cardiac disease; group 2 = patients at ris...

Pre-operative laboratory testing: A prospective study on comparison and cost analysis

“…Studies have looked into the need for the routine ECGs and chest radiographs. [131415] In a large study involving 6111 patients undergoing elective surgery, the usefulness of routine chest radiographs and its influence on anaesthetic management was evaluated. [16] They found 18.3% were abnormal out of which only 5.1% (313 patients) were considered as useful which altered anaesthetic management.…”

Routine preoperative testing: a systematic review of the evidence.

“…Our search identified 30 studies of preoperative electrocardiography, of which 16 reported outcome data in a usable form. 35,37,40,[45][46][47][48]56,57,[59][60][61][62][63][64][65] All were simple case-series. Nine studies were in adults, 37,40,45,46,56,57,60,63,65 two studies in both adults and children, 47,64 and in the remainder of the studies the age of the study population was not specified.…”

Das präoperative EKG als Routineuntersuchung bei Kindern

“…Da bei der Planung einer Operation immer mehrere Ärzte beteiligt sind, macht es durchaus Sinn zu überlegen, ob ein standardisiertes Programm für präope-rative Untersuchungen zur Risikominderung beitragen kann. Während es für erwachsene Patienten eine umfangreiche Literatur über die Notwendigkeit von präoperativen Untersuchungen gibt [4, 10, 25, 30, 47-49, 63, 65] [4,6,12,13,15,17,18,20,25,39,43,45,47,49].…”