The Value of Pre-operative ECGs in elective surgical patients

Introduction: The value of routine pre-operative ECGs has been debated. This study was done in S.N. Medical College, Agra between January 2004 to June 2005. We included patients aged 17-90 years of age, admitted in various surgical specialties. Method: In our hospital, routine ECG testing is done in all patients above 45 years age & below this age only if indicated. Routine pre-operative ECGs were analysed in terms of frequency of abnormalities and whether or not peri-operative management was changed, when the result was abnormal. The frequency of results being present in the notes at the time of operation, and the costing of the tests was also examined. Results: Total number of ECGs performed were 412, but abnormality was seen in only half the ECGs. Pre-operative intervention was done in 21 patients. Out of these, 5 cases were postponed. Anaesthetic M/N was altered only in 3 patients, with only 2 patients exhibiting complication (hypotension). It is conservatively estimated that a saving of Rs 28,016 (Rs. 68 per test-current rates) per year could be made in our hospital alone by selective ordering of ECGs. Conclusions: It was concluded from this study that ECGs should not be done blindly for screening purposes in healthy surgical patients, as it is inefficient, unnecessary & expensive. The pre-operative ECGs should be done according to patient's age, ASA grade and type of operation, after thorough pre-anaesthetic check up of the patients.