Does Stress test before non-cardiac surgery prevent or reduce mortality? Do we have good evidence for doing stress test before non-cardiac surgery?
Around 5 million major surgical procedures to parts of the body other than heart occur in the US. In order to prevent heart-related problems due to the surgery, the common practice is to do stress testing prior. Stress testing is costly, but this may also require the patients to undergo medical or additional surgical treatment for heart problems identified during the test, and also cause a delay in surgery that may lead to adverse events. Dr. Balady noticed that there was no quality evidence to indiscriminately perform stress testing and this resulted in vague guidelines.
Dr. Balady and his team of residents collaborated with Dr. Kalesan, an epidemiologist, to systematically pool all the available published evidence on this subject. After analysis of 79 studies, we found that none of the studies were of good quality and most did not use a comparison group. The results of this meta-analysis suggest that due to inadequate quality studies, a randomized control trial to test the effectiveness of stress testing for patients undergoing major non-cardiac surgery is required to curb unwanted procedures and reduce cost.