The pre-operative ECG in day surgery: a habit?

As the population presenting for day-case surgery and anaesthesia increases, so does the challenge of adequate pre-operative assessment. Although an electrocardiogram is frequently performed, its value in day-case surgery remains unproven. One thousand, one hundred and eighty-five patients presenting for day-case surgery were assessed. One hundred and fifty-four (13%) were referred for electrocardiogram according to well-recognised criteria for the prediction of coronary artery disease. They were read independently by the anaesthetist responsible for the case and by an experienced cardiologist. A significant abnormality was noted in 26% of electrocardiograms, most frequently in patients referred with hypertension. There was a good correlation between the reports of the anaesthetist and cardiologist. Only 20% of those patients with an abnormal electrocardiogram had their surgery postponed. No adverse events occurred in patients proceeding to surgery despite the abnormalities. We conclude that a resting electrocardiogram is of limited value in risk stratification of patients undergoing day-case surgery.