To the Editor:--Several authors have questioned the value of the routine preoperative electrocardiogram (ECG) for healthy patients. [1,2]We surveyed all U.S. and Canadian teaching hospitals and attempted to survey an equal number of hospitals of the same size without teaching programs to learn current practices for preoperative ECGs. A total of 182 teaching hospitals and 270 nonteaching hospitals received surveys. The percentage of hospitals responding to the survey was 94% for teaching and 49% for nonteaching institutions. [3].
Our survey found that more than 60% of both teaching and private institutions ordered preoperative ECGs for men older than 40 yr, and more than 80% ordered preoperative ECGs for women older than 50 yr (Table 1). By comparison, a consensus development panel convened by the University Hospital Consortium [4]concluded that preoperative ECGs should be ordered in all men older than 40 and all women older than 50 and all others with specific clinical indications (19 respondents, 66% agreement). Although the practice of ordering preoperative ECGs for men older than 40 and women older than 60 yr is common, almost one-third of the hospitals we surveyed recently increased the age at which an ECG is ordered. In 23% of the hospitals surveyed, preoperative ECGs are required by hospital policy rather than anesthesia department policy, and about 29% of the hospitals surveyed reported that surgeons ordered ECGs independently of anesthesia department guidelines. Approximately 10% of the hospitals surveyed stated that third-party payers now dictate the patient age for which preoperative ECGs will be paid. Finally, 72% of respondents believed that health status was more important in ordering an ECG than either age or type of procedure.
Table 1. Minimum Age at Which Anesthesia Departments Routinely Order Electrocardiograms for Patients without Cardiac Risk Factors
We believe our survey indicates that preoperative ECG ordering practices are changing and that the majority of anesthesiologists are prepared to order ECGs based on the patient's health status rather than age. We speculate that, as managed health care increases, clinical justification will be required before ordering a preoperative ECG. The results of our survey may be helpful to others in formulating policy in an era of managed health care.
A. Colin McKinley, M.D., Assistant Professor.
Anne T. Rogers, M.B.Ch.B., Associate Professor.
Robert James, Biostatistician, Department of Anesthesia, The Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, North Carolina 27157–1009.
