Investigators have learned preoperative testing before low-risk surgery carries no benefits. In fact, they concluded routine preoperative testing is overused, costly, and may even cause harm.1
“There is a lot of strong evidence, the basis of the study, that shows that routine testing before low-risk surgery does not prevent adverse events and has downstream harm,” says Lesly Dossett, MD, MPH, assistant professor of surgery at the University of Michigan.
For example, delaying a patient’s cataract surgery because of preoperative testing could lead to a fall and an injury. The often-unnecessary routine tests include ECGs, X-rays, comprehensive metabolic panels, and coagulation studies.
“A number of perioperative, anesthesia, and surgical specialty societies have recommended against routine testing,” Dossett notes. “We found that despite those recommendations, a high percentage of patients still go through routine testing ... we think it’s an opportunity to improve value by eliminating these tests unless there’s a strong clinical indication for it.”
Dossett believes the main reason unnecessary preoperative testing continues is because of habit. “Another thing we think happens is that when patients are sent to other providers for preoperative clearance, those providers have a lot of momentum to order tests,” she adds. “When there are separately billed pre-op history and physical, more tests are ordered.”
Also, surgeons want to avoid cancellations. Surgeons might think if they ensure no stone goes unturned before a procedure, then they will prevent cancellations.
“That has been shown to not be the case,” Dossett says. “Routine testing [in low-risk procedures] does not demonstrate a reduction in cancellations, and it doesn’t prevent adverse events like heart attacks and strokes.”
- Berlin NL, Yost ML, Cheng B, et al. Patterns and determinants of low-value preoperative testing in Michigan. JAMA Intern Med 2021; May 17. doi: 10.1001/jamainternmed.2021.1653. [Online ahead of print].