Is Imaging Before Surgery Worthless?

Heart ultrasounds before elective surgery may not improve survival

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) Before most elective surgeries such as nose jobs or facelift, patients get a heart ultrasound. It's designed to predict which patients could have complications, but it may not result in improved survival.

Patients who get a echocardiography before major elective surgery do not appear to have better survival rates one month or one year following the operation.

"Inquire if pre-operative tests are really needed."

Dr. Duminda Wijeysundera, a scientist at the Li Ka Shing Knowledge Institute of St. Michael's Hospital and the Institute for Clinical Evaluative Sciences, and an anesthesiologist at Toronto General Hospital, said that some patients even had worse survival rates, suggesting the imaging may be an unnecessary health care cost that needlessly delays surgeries.

He said the finding has important implications for the thousands worldwide who undergo surgery each day.

The research suggests heart ultrasounds may not be helpful in identifying which patients are likely to have complications after surgery. Dr. Wijeysundera said that more testing is not necessarily better, and that given echocardiography may actually cause harm, doctors should reconsider its role for patients undergoing elective surgery.

Researchers found that 15 percent of about 265,000 Ontario residents who underwent major surgery between 1999 and 2008 had echocardiograms before the operation, making it one of the most commonly used pre-operative tests.

It was discovered that patients that did not undergo cardiac stress testing, but had two or fewer risk factors such as diabetes, kidney disease or a history of heart disease, had a higher chance of dying within a year of surgery.

Dr. Wijeysundera  previously found that patients with at least one risk factor for complications after surgery have a better survival rate if they undergo cardiac stress testing prior to the operation. However, though there are better outcomes with stress testing, Ontario doctors were 50 percent more likely to order heart ultrasounds.

Dr. Wijeysundera said one reason that heart ultrasounds may not perform as well in identifying high risk patients is because some physicians were incorrectly reassured that some high-risk patients could safely undergo an operation without the need for specialized care.

Some doctors also may have incorrectly believed that certain low risk patients required specialized care, prompting them to give the patients unnecessary and potentially harmful treatment.

The research was published in the British Medical Journal.

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Review Date: 
August 19, 2011
Last Updated:
August 21, 2011