Don’t order a baseline electrocardiogram for asymptomatic patients undergoing low-risk non-cardiac surgery.

Electrocardiograms (ECGs) performed before elective, non-cardiac, surgeries are frequently abnormal. This is especially true when this test is done in older patients. Despite the frequency of these abnormalities, ECGs do little to improve risk prediction beyond simply asking patients about their health. Serious cardiac events like heart attack are rare following low-risk surgeries; there is little that physicians can do to further lower this risk. A preoperative ECG will therefore not improve outcome but may lead to more testing or treatment that is of little benefit. ECGs used to identify the cause of symptoms (palpitations, chest pain, dyspnea, etc.) remain useful diagnostic tools regardless of whether the patient is having surgery.

Sources:

Liu LL, et al. Preoperative electrocardiogram abnormalities do not predict postoperative cardiac complications in geriatric surgical patients. J Am Geriatr Soc. 2002 Jul;50(7):1186-91. PMID: 12133011.

Mathis MR, et al. Patient selection for day case-eligible surgery: identifying those at high risk for major complications. Anesthesiology. 2013 Dec;119(6):1310-21. PMID: 24108100.

van Klei WA, et al. The value of routine preoperative electrocardiography in predicting myocardial infarction after noncardiac surgery. Ann Surg. 2007 Aug;246(2):165-70. PMID: 17667491.

Related Resources:

Patient Pamphlet: ECG (Electrocardiogram): When you need it and when you don’t

Toolkit: Drop the Pre-Op – A toolkit for reducing unnecessary visits and investigations in pre-operative clinics