The value of the electrocardiogram as a routine preoperative examination

OBJECTIVE To review systematically the available evidence on the value of the routine preoperative electrocardiogram ( ECG). METHOD The frequency of abnormal ECG findings, the incidence of perioperative complications and the need for changes in the clinical management of patients with an abnormal ECG were recorded for all the studies reviewed. The predictive value of the routine preoperative ECG was been calculated wherever possible. The quality of the studies review was appraised. RESULTS Twenty-four studies were reviewed and their outcome was calculated when possible. The positive predictive value of the routine preoperative ECG for clinical management ranged from 0 to 0.36 (0% to 36%), while the positive predictive value for perioperative complications was even lower, ranging from 0 to 0.017 (0% to 1.7%). In general the patients' age and clinical status, information from the medical history and the clinical examination, and also the kind of operation are the elements which are taken into consideration when recommendations are formulated. CONCLUSIONS Recording a routine preoperative ECG in younger patients and in patients in good health does not offer any extra advantages. The findings of the routine preoperative ECG lead to a change in clinical management in only a small proportion of patients. Its value is even lower considering the scant information it adds to that already available from the history and clinical examination. Many authors recommend preoperative ECG recording only when there are indications and a high-risk operation is planned. In order to reach safer conclusions on the value of the routine preoperative ECG, randomized, controlled, multicentre studies with stratified analysis are needed.