Planning for surgery? You may not need all those tests up front.

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Sometimes a preoperative test of questionable value leads to unexpected complications, as happened to a man in his fifties waiting for repair of a very painful hernia. Two doctors from Colorado reported in 2014 that the laboratory tests and physical examination of the man were normal. But a chest X-ray, ordered because she had a history of mild asthma, suggested she had a lump on one lung.

Doctors delayed surgery until he got a CT scan, which didn’t confirm a lung lump but found one on an adrenal gland. Again, doctors postponed surgery to allow for further work on the adrenal nodule, which ultimately turned out to be benign. The man finally had his hernia repaired after another six months of debilitating pain and repeated anxiety over accidental test results suggesting he may have cancer.

However, doctors are making progress. In 2019 in JAMA Internal Medicine, Dr. John N. Mafi, 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 undergo surgery. of cataracts. New guidelines were issued and a Quality Improvement Nurse recommended the new recommended protocol to surgeons. The result, as assessed in a controlled clinical trial of 1,054 patients, was a drastic drop in preoperative testing, significant expected cost savings after the first year, and “no measurable adverse effects” on patients’ surgery, he said.

Perhaps the most problematic of common preoperative procedures is a cardiac stress test, which evaluates blood flow to the heart as patients exercise. Dr. Alana E. 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, “The cardiac stress test is superordinate. If there are no indications of a heart problem, such as shortness of breath, there is no reason to have this test done before surgery. “

The latest guidelines, which the American College of Cardiology and the American Heart Association issued in 2014, inform that a cardiac stress test before surgery is generally not recommended for patients without symptoms suggestive of heart disease. The guidelines leave the decision of the test to the doctor, and you may think it is best to rule out a possible heart problem before surgery. But the existing evidence shows no health or life-saving benefits from a preoperative stress test when the patient has no heart symptoms or has fewer than two main risk factors for having a heart attack, such as hypertension and smoking, especially. when any surgery is low-risk.

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