Indications for electrocardiogram in the preoperative assessment for programmed surgery

OBJECTIVES: To establish indications for ordering a screening electrocardiogram (ECG) before scheduled surgery. To study the prevalence of abnormalities found in routine ECGs and the impact of routine ECGs on anesthetic and surgical management and on preventing perioperative complications. MATERIAL AND METHODS: A prospective study of 413 patients undergoing scheduled non-cardiac surgery over a two-year period. ECG anomalies were defined as major or minor in function of their association with perioperative morbimortality. ECG results were considered expected or unexpected in function of agreement with a patient's history. RESULTS: An ECG was done for all patients before surgery. Anomalies were observed in 41.9% of the ECGs, 28.6% of which were considered major. The prevalence of anomalies was greater among men over 40 years of age, with heart or respiratory disease and these classified as ASA III-V. The anomalies were unexpected in 8.9% and did not cause postponement or cancellation of scheduled procedures. Anomalies found led to changes in preoperative approach in 0.5% of the cases. Intraoperative complications were seen in 7.9% and postoperative complications in 24.6%. CONCLUSIONS: Preoperative ECGs should be obtained only in patients over 40 years of age who present cardiac or respiratory signs or symptoms and who are diagnosed of some heart or respiratory disease.