Physicians Should Consider Indications Before Ordering Preoperative Cardiac Testing

[...]I offer a caveat about the recommendation to forego preoperative testing before cataract surgery, which was based on a large randomized trial.1 One fact about this study that is rarely mentioned is that patients were excluded if they received general anesthesia. Many cataract surgeries are done under general anesthesia with endotracheal intubation. [...]the risk of complications in patients receiving general anesthesia with intubation would be higher even in this low-risk surgery, and may indicate the need for specific preoperative testing. In a prospective cohort study published in 2000, risk factor assessment predicted 97% of patients with abnormal serum creatinine levels.1 On the other hand, preprocedural measurement of serum creatinine may be warranted even in healthy patients undergoing high-risk procedures that require a large intravenous contrast bolus, or a prolonged procedure that carries a high risk of concomitant hypotension in addition to the use of intravenous contrast media.