Utility of the routine electrocardiogram before surgery and on general hospital admission. Critical review and new guidelines.

No consensus has been reached regarding the need for a routine 12-lead electrocardiogram (ECG) preoperatively or on general admission in adult patients. Critical review of relevant studies reveals important weaknesses and gaps in the data needed to formulate definitive recommendations. Available data, however, do not support the necessity for obtaining a baseline or screening ECG in all adult patients before surgery involving general or regional anesthesia or on hospital admission for other indications. To reduce costs related to unnecessary tests and false-positive results, routine use of the ECG is warranted only in selected subsets of hospitalized patients, including those with cardiac signs or symptoms and those at risk for occult heart disease, particularly older patients.