But existing evidence shows no health or lifesaving benefit from a preoperative stress test when the patient lacks cardiac symptoms or has fewer than two major risk factors for having a heart attack, like high blood pressure and smoking, especially when the prospective surgery itself is low-risk. The guidelines leave the decision to test up to the doctor, and you might think it’s better to rule out a possible heart problem before surgery. The latest guidelines, which the American College of Cardiology and American Heart Association issued in 2014, advise that a cardiac stress test before surgery is generally not recommended for patients lacking symptoms suggestive of heart disease.
If there’s no indication of a heart problem, like shortness of breath, there’s no reason to do this test prior to surgery.” Sigmund, an internal medicine physician at the Hospital for Special Surgery in New York who has studied physicians’ responses to preoperative guidelines, said in an interview, “Cardiac stress testing is over-ordered.
Perhaps most problematic among common preoperative procedures is a cardiac stress test, which assesses blood flow to the heart while patients exercise. Cardiac stress tests show over-testing persists.
The result, as assessed in a controlled clinical trial of 1,054 patients, was a dramatic decline in preoperative testing, a significant projected cost saving after the first year and “no measurable adverse effects” on the patients’ surgery, he said. New guidelines were issued, and a specially trained quality improvement nurse advised the surgeons about the new recommended protocol. Mafi, an internist at the David Geffen School of Medicine at the University of California, Los Angeles, and his colleagues described an effort to reduce “low-value preoperative care” for patients about to have cataract surgery. However, doctors are making some headway. The man finally had his hernia repaired after six additional months of debilitating pain and repeated anxiety over incidental test findings suggesting he could have cancer. Again, doctors postponed surgery to allow for further work-up of the adrenal nodule, which was ultimately found to be benign. The only exception was a decline in the use of electrocardiograms, or EKGs, a noninvasive test that checks heart function at rest.ĭoctors delayed the surgery until he got a CT scan, which did not confirm a lung nodule but did find one on an adrenal gland.
Guidelines published in 2002, for example, from the American College of Cardiology, the American Heart Association and the American Society of Anesthesiologists resulted in almost no change in doctors’ presurgical orders nearly a decade later, according to a report in JAMA Internal Medicine. Yet practicing doctors often do not follow this advice. Many of these tests are a waste of time and money, a growing body of research shows, and the tests themselves can sometimes result in complications.įor more than two decades, experts in various medical specialties, including cardiology, ophthalmology and anesthesiology, have issued guidelines directed at reducing preoperative tests that rarely provide findings relevant to a patient’s surgical risk. It’s normal to feel anxious about any upcoming surgery.īut what if one of the presurgical tests your doctor orders - for example, a chest X-ray or cardiac stress test - turns up something unexpected, like a suspicious nodule or a mild heart abnormality? Now you have even more reason to worry, and your surgery will likely be delayed until further tests assure the doctor it would be safe to operate.Įxperts say that presurgical testing is often unjustified for many common operations. Let’s say you’re scheduled for a common and relatively low-risk operation, like a cataract removal, hernia repair or a hip or knee replacement.