When should we order preoperative electrocardiography: A systematic review and clinical practice guidelines.

ABSTRACT

Routine preoperative investigation consumes many resources at the time when Thailand is suffering a severe financial crisis. The objectives of the study were to apply a systematic review to answer the question if routine preoperative investigation affects health outcomes; and to construct clinical practice guidelines for preoperative electrocardiography (ECG). The guidelines were prepared for elective, non-cardiothoracic surgery in adult patients. Methods of the study were a Medline search (1980-1998) and a search of studies published in Thailand. Criteria for high validity and reliability were applied to paper selection. The results of the systematic review were discussed among anesthesiologists and other specialists and the guidelines were drawn by consensus. Results from systematic review found that there were no randomized controlled trials to answer the question and no studies reported health outcomes. Routine preoperative investigation yielded few positive results and were not very useful for patient care. From this review and consensus, we proposed the following guidelines a history questionnaire, physical examination, and indication for investigation. For the preoperative ECG, the indications are age > 45 years, history of hypertension, heart disease, palpitation or frequent syncope, diabetes, chronic cough for > 3 weeks or pulmonary disease, heavy smoking (> 10 pack /days for> 10 years), radiotherapy or chemotherapy. Preoperative ECG carried out according to these guidelines would be more cost-effective and routine preoperative investigation should be abandoned.