Routine preoperative tests for low risk surgeries results in unnecessary delays, potential distress for patients and significant cost for the health care system. Numerous studies and guidelines outline lack of evidence for benefit in routine preoperative testing (e.g., chest X-ray, echocardiogram) in low risk surgical patients. Economic analyses suggest significant potential cost savings from implementation of guidelines.

Conditions: Pre-Operative (Pre-Op Assessment), Low-Risk Surgery

Diagnostic Tests: Chest X-Rays (CXR), Echocardiograms, TTE, Cardiac Stress Tests, Stress ECG Testing, GXT, Stress Imaging, Stress Nuclear, Stress MIBI, Stress Echo

Sources

• Benarroch-Gampel J, Sheffield KM, Duncan CB, Brown KM, Han Y, Townsend CM,Jr, et al. Preoperative laboratory testing in patients undergoing elective, low-risk ambulatory surgery. Ann Surg. 2012 Sep;256(3):518-28. (PubMed)
• Chee YL, Crawford JC, Watson HG, Greaves M. Guidelines on the assessment of bleeding risk prior to surgery or invasive procedures. British Committee for Standards in Haematology. Br J Haematol. 2008 Mar;140(5):496-504. (PubMed)
• Chung F, Yuan H, Yin L, Vairavanathan S, Wong DT. Elimination of preoperative testing in ambulatory surgery. Anesth Analg. 2009 Feb;108(2):467-75. (PubMed)
• Fleisher LA, Beckman JA, Brown KA, Calkins H, Chaikof EL, Fleischmann KE, et al. ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery) developed in collaboration with the American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, and Society for Vascular Surgery. J Am Coll Cardiol. 2007 Oct 23;50(17):e159-241. (PubMed)
• Fritsch G, Flamm M, Hepner DL, Panisch S, Seer J, Soennichsen A. Abnormal pre-operative tests, pathologic findings of medical history, and their predictive value for perioperative complications. Acta Anaesthesiol Scand. 2012 Mar;56(3):339-50. (PubMed)
• Institute of Health Economics. Routine preoperative tests - are they necessary? 2007 May [cited 2014 Feb 10]. (IHE)
• May TA, Clancy M, Critchfield J, Ebeling F, Enriquez A, Gallagher C, et al. Reducing unnecessary inpatient laboratory testing in a teaching hospital. Am J Clin Pathol. 2006 Aug;126(2):200-6. (PubMed)
• National Institute for Clinical Excellence. Preoperative tests: The use of routine preoperative tests for elective surgery. 2003 June [cited 2014 Feb 10]. (PDF)