The Society of Thoracic Surgeons

View all recommendations from this society

Released February 21, 2013

Patients who have no cardiac history and good functional status do not require preoperative stress testing prior to non-cardiac thoracic surgery.

  • Functional status has been shown to be reliable for prediction of perioperative and long-term cardiac events. In highly functional asymptomatic patients, management is rarely changed by preoperative stress testing. It is therefore appropriate to proceed with the planned surgery without it.

Unnecessary stress testing can be harmful because it increases the cost of care and delays treatment without altering surgical or perioperative management in a meaningful way. Furthermore, low-risk patients who undergo preoperative stress testing are more likely to obtain additional invasive testing with risks of complications.

Cardiac complications are significant contributors to morbidity and mortality after non-cardiac thoracic surgery, and it is important to identify patients preoperatively who are at risk for these complications. The most valuable tools in this endeavor include a thorough history, physical exam and resting EKG. Cardiac stress testing can be an important adjunct in this evaluation, but it should only be used when clinically indicated.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

The Society of Thoracic Surgeons (STS) list development process was led by the First Vice-President, and involved input from multiple workforces, including the Workforce on Adult Cardiac and Vascular Surgery, Workforce on General Thoracic Surgery, and Workforce on Evidence Based Surgery, and was staffed by STS’ Director of Quality. The initial 17 recommendations from these Workforces were narrowed down to eight based upon frequency, clinical guidelines and potential impact. STS leadership approved these eight recommendations for presentation to members in an online survey. The results of the survey, as well as research and systematic literature review by the Workforce on Evidence Based Surgery, were presented to the STS Executive Committee, which approved the five final recommendations.

Sources

Fleisher LA, Beckman JA, Brown KA, Calkins H, Chaikof E, Fleischmann KE, Freeman WK, Froehlich JB, Kasper EK, Kersten JR, Riegel B, Robb JF, Smith SC Jr, Jacobs AK, Adams CD, Anderson JL, Antman EM, Buller CE, Creager MA, Ettinger SM, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Hunt SA, Lytle BW, Nishimura R, Ornato JP, Page RL, Tarkington LG, Yancy CW. ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for non-cardiac surgery: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Non-cardiac Surgery). Circulation. 2007 Oct 23;116:e418-99.

Poldermans D, Bax JJ, Boersma E, De Hert S, Euckhout E, Fowkes G, Gorenek B, Hennerici MG, Iung B, Kelm M, Per Kjeldsen K, Kristensen SD, Lopez-Sendon J, Pelosi P, Philippe F, Pierard L, Ponikowski P, Schmid J-P, Sellevold OFM, Sicari R, Van den Berghe G, Vermassen F. Guidelines for preoperative cardiac risk assessment and perioperative cardiac management in non-cardiac surgery. The task force for preoperative cardiac risk assessment and perioperative cardiac management in non-cardiac surgery of the European Society of Cardiology and endorsed by the European Society of Anaesthesiology. Eur Heart J. 2009;30:2769–812.

Brunelli A, Varela G, Salati M, Jimenez MF, Pompili C, Novoa N, Sabbatini A. Recalibration of the revised cardiac risk index in lung resection candidates. Ann Thorac Surg. 2010;90:199–203.

Wijeysundera DN, Beattie WS, Elliot RF, Austin PC, Hux JE, Laupacis A. Non-invasive cardiac stress testing before elective major non-cardiac surgery: Population based cohort study. BMJ. 2010;340:b5526.