Planning for surgery? You may not need all of these tests first.

Sometimes a preoperative test of questionable value leads to unforeseen complications, as happened with a man in his fifties who had to h...


Sometimes a preoperative test of questionable value leads to unforeseen complications, as happened with a man in his fifties who had to have a very painful hernia repaired. Two Colorado Doctors reported in 2014 that the laboratory tests and physical examination of the man were normal. But a chest x-ray, ordered because he had a history of mild asthma, suggested he had a lump on one lung.

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

However, doctors are making progress. In 2019 JAMA Internal Medicine, Dr. John N. Mafi, internist at the David Geffen School of Medicine at the University of California, Los Angeles, and colleagues described an effort to reduce “low-value preoperative care” for patients on the verge of to have cataract surgery. New guidelines were published and a quality improvement nurse advised surgeons on the new recommended protocol. The result, as evaluated in a controlled clinical trial of 1,054 patients, was a dramatic decrease in preoperative testing, a significant cost savings expected after the first year and “no measurable adverse effects” on the patients’ surgery, a he declared.

The cardiac stress test, which measures blood flow to the heart while patients exercise, is perhaps the most problematic among common preoperative procedures. Dr. Alana E. Sigmund, an internal medicine physician at the Hospital for Special Surgery in New York City who has studied physicians’ responses to preoperative guidelines, said in an interview: “Cardiac stress tests are over-ordered. If there is no indication 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 published in 2014, advise that a cardiac stress test before surgery is generally not recommended for patients without symptoms suggestive of heart disease. The guidelines leave it up to the doctor to do the test, and you might think it’s best to rule out a possible heart problem before surgery. But existing evidence shows no health or survival benefit from a preoperative stress test when the patient has no heart symptoms or has fewer than two major risk factors for heart attack, such as high blood pressure and smoking, especially when the prospective surgery itself is weak. risk.

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Newsrust - US Top News: Planning for surgery? You may not need all of these tests first.
Planning for surgery? You may not need all of these tests first.
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