An Audit of the Value of Pre-Operative Electrocardiograms before Surgery (General Anaesthetic) in a Day Surgery Unit

BACKGROUND: As the population presenting for day-case surgery and anaesthesia increases, so does the challenge of adequate pre-operative assessment. The resting 12-lead electrocardiogram (ECG) is relatively insensitive and frequently normal even in the presence of severe coronary artery disease but it is quick, easy to perform and frequently requested, thus its value in day-case surgery remains unproven. AIMS: To assess whether patients at Day Surgery Unit, Gartnavel General Hospital who fit the ECG criteria get an immediate ECG and also to review whether abnormal ECG results leads to any change in the patient's management. METHODS: A prospective audit was performed on all patients coming in for noncardiac day-case surgery over a 3-week period between February 2006 and March 2006. Patient notes were reviewed before their surgery. RESULTS: 60 patients presenting for day-case surgery over this period should have had an ECG done but only 24 were referred. A significant abnormality was noted in 12.5% of ECGs. None of these patients had their surgery postponed or management changed. No adverse events occurred in patients proceeding to surgery and there were no cases of peri-operative cardiovascular complications or admissions to hospital. CONCLUSION: The finding of ECG abnormalities did not prevent the patient proceeding directly to anaesthesia and surgery. Furthermore, they did not predict intra-operative, postoperative complications or hospital admission following the procedure. The ECG is of limited value in the risk stratification of patients selected for day-case surgery.