Stress Testing Before Low-Risk Surgery | Journal Scan

Mar 27, 2015
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Authors:
Kerr EA, Chen J, Sussman JB, Klamerus ML, Nallamothu BK.
Citation:
Stress Testing Before Low-Risk Surgery: So Many Recommendations, So Little Overuse. JAMA Intern Med 2015;Feb 9:[Epub ahead of print].
Summary By:
Troy M LaBounty, MD, FACC

Study Questions:

How common is preoperative stress testing prior to low-risk surgery?

Methods:

The authors examined rates of preoperative stress testing in patients ≥65 years of age, and included 22,670 patients from Veteran Administration (VA) hospitals and 109,270 Medicare patients undergoing cataract surgery, knee arthroscopy, or shoulder arthroscopy in 2009. Data were obtained using the Veteran Administration Corporate Data Warehouse and a sample of Medicare fee-for-service claims.

Results:

Mean age was 76 years in both cohorts, while males comprised 98% of the VA cohort and 47% of the Medicare cohort. Preoperative stress testing was performed in 0.7% of patients at VA centers and 2.1% of Medicare patients. Rates of preoperative stress testing by referral area ranged from 0.3% to 2.0% for VA sites and 1.5% to 3.1% for Medicare patients.

Conclusions:

The authors concluded that preoperative stress testing is rarely performed prior to cataract surgery or joint arthroscopy.

Perspective:

As the authors discuss, the Choosing Wisely campaign and consensus guidelines recommend avoiding routine stress testing prior to low-risk surgery. These results suggest that preoperative stress testing is not common in this group, at least among patients planned for joint arthroscopy and cataract surgery. These findings suggest that the Choosing Wisely campaign may benefit from targeting other groups undergoing excess preoperative testing. For example, a campaign to avoid routine stress testing in low-risk patients or those with at least moderate functional capacity may have a larger effect if this is an area of greater overuse. Similarly, routine perioperative electrocardiogram testing is often not needed in low-risk patients, and this may represent another area of overtesting. This is an important area of research that may help us design more effective patient and physician outreach programs.

Keywords: Arthroscopy, Cataract, Exercise Test, Electrocardiography, Fee-for-Service Plans, Medicare, Referral and Consultation, Veterans, Elective Surgical Procedures, Diagnostic Imaging, Geriatrics


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