STS News, Spring 2013 -- On February 21, the Society released a list of “Five Things Physicians and Patients Should Question” in cardiothoracic surgery as part of the Choosing Wisely® campaign, led by the American Board of Internal Medicine Foundation. The list identifies five evidence-based recommendations that can support physicians and patients in making wise choices about their health care. STS President Douglas E. Wood, MD participated in a press conference that day in Washington, DC, along with representatives from 16 other medical specialty societies that also released lists.
Choosing Wisely is an initiative focused on helping physicians to become better stewards of finite health care resources and encouraging physicians and patients to discuss appropriate medical decision making. With its five recommendations, STS hopes to challenge common medical practice—practice that may be embedded in tradition, routine, or defensive medicine, but may not have good justification.
“STS has long been a leader in data-driven and patient-centered health care,” Dr. Wood said. “Choosing Wisely allows the Society to continue that leadership alongside like-minded specialty societies to empower the physician-patient dialogue so as to help avoid unnecessary procedures that may harm patients while driving up health care costs.”
STS worked on its list for several months. The process started with 17 recommendations from the Workforce on Adult Cardiac and Vascular Surgery and the Workforce on General Thoracic Surgery. After the recommendations were narrowed to eight by the Workforce chairs and Dr. Wood, US-based STS members were asked their opinions in an online survey. Additionally, members of the Workforce on Evidence Based Surgery were assigned to search the literature and see whether the available scientific evidence supported the draft recommendations.
Based on the membership survey, evidentiary support, and final discussion by the STS Executive Committee, the following five recommendations were selected:
1. Patients who have no cardiac history and good functional status do not require pre-operative stress testing prior to non-cardiac thoracic surgery.
2. Don’t initiate routine evaluation of carotid artery disease prior to cardiac surgery in the absence of symptoms or other high-risk criteria.
3. Do not perform a routine pre-discharge echocardiogram after cardiac valve replacement surgery.
4. Patients with suspected or biopsy-proven Stage I non-small cell lung cancer do not require brain imaging prior to definitive care in the absence of neurological symptoms.
5. Prior to cardiac surgery, there is no need for pulmonary function testing in the absence of respiratory symptoms.
Learn more about Choosing Wisely, watch an archived webcast of the February 21 event featuring Dr. Wood, and read all 27 lists released to date at www.choosingwisely.org. You can also read more about the Society’s process in determining these recommendations, as well as in-depth descriptions and citations for each recommendation, in the March issue of The Annals of Thoracic Surgery.