Five Commonly Used Cardiothoracic Surgery Tests and Treatments Questioned


Open communication urged between physicians and patients to make better decisions about health care

CHICAGO (Feb. 21, 2013) – The Society of Thoracic Surgeons (STS) today released a list of specific tests and procedures that are commonly ordered, but not always necessary in cardiothoracic surgery. The list is part of the Choosing Wisely® campaign, an initiative of the American Board of Internal Medicine (ABIM) Foundation that identifies targeted, evidence-based recommendations that can support conversations between patients and physicians about what care is really necessary.

STS made the following five recommendations for cardiothoracic surgery:

    • Patients who have no cardiac history and good functional status do not require preoperative stress testing before noncardiac thoracic surgery;
    • Do not initiate routine evaluation of carotid artery disease before cardiac surgery in the absence of symptoms or other high-risk criteria;
    • Do not perform a routine predischarge echocardiogram after cardiac valve replacement surgery;
    • Patients with suspected or biopsy proven stage I non-small cell lung cancer do not require brain imaging before definitive care in the absence of neurologic symptoms; and
    • Before cardiac surgery, there is no need for pulmonary function testing in the absence of respiratory symptoms.

All five recommendations and the process of selecting the final list are outlined in a Special Report in the March 2013 issue of The Annals of Thoracic Surgery.

“The STS has long been a leader in data-driven and patient-centered health care,” wrote STS President Douglas E. Wood, MD and colleagues. “Choosing Wisely allows the STS to continue that leadership alongside like-minded specialty societies to empower the physician-patient dialogue and to avoid unnecessary procedures that may harm patients while driving up health care costs.”

By releasing the Choosing Wisely list, the Society hopes to challenge common practice - practice that may be imbedded in tradition, routine, or defensive medicine, but may not have good justification, according to Dr. Wood. The list is not meant to be rigid or constraining; the goal is for open communication between surgeons and patients to empower the two together to make better decisions about health care choices.

Sharing in this goal and releasing lists along with STS at a Washington, DC, press conference were 16 other organizations representing more than 350,000 physicians, nurses, pathologists, radiologists, and other health care professionals. To view the full listing, click here.

To date, more than 130 tests and procedures to question have been released as part of the Choosing Wisely campaign, and the specialty societies responsible for these recommendations are now undertaking considerable efforts to share them with their collective memberships of more than 725,000 physicians.

To learn more about Choosing Wisely and to view the complete lists, with additional detail about the recommendations and evidence supporting them, visit You can also view a video of the press conference here.


About The Society of Thoracic Surgeons
Founded in 1964, STS is a not-for-profit organization representing more than 6,600 cardiothoracic surgeons, researchers, and allied health care professionals worldwide who are dedicated to ensuring the best possible outcomes for surgeries of the heart, lung, and esophagus, as well as other surgical procedures within the chest. The Society’s mission is to enhance the ability of cardiothoracic surgeons to provide the highest quality care through education, research and advocacy.

About the ABIM Foundation
The mission of the ABIM Foundation is to advance medical professionalism to improve the health care system. We achieve this by collaborating with physicians and physician leaders, medical trainees, health care delivery systems, payers, policy makers, consumer organizations and patients to foster a shared understanding of professionalism and how they can adopt the tenets of professionalism in practice. To learn more about the ABIM Foundation, visit, read our blog, connect with us on Facebook or follow us on Twitter.

About Choosing Wisely
First announced in December 2011, Choosing Wisely is part of a multi-year effort led by the ABIM Foundation to support and engage physicians in being better stewards of finite health care resources. Participating specialty societies are working with the ABIM Foundation and Consumer Reports to share the lists widely with their members and convene discussions about the physician’s role in helping patients make wise choices. Learn more at