Common Myths about Pre-Op Testing
Common Myths about Pre-Op Testing
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"It's better to be safe than sorry."
"It's better to be safe than sorry."
FACT: If a healthy patient is undergoing a low-risk surgery, evidence shows that preoperative tests do not improve surgical safety outcomes for the patient and/or alter the surgical plan for the day of surgery.
FACT: If a healthy patient is undergoing a low-risk surgery, evidence shows that preoperative tests do not improve surgical safety outcomes for the patient and/or alter the surgical plan for the day of surgery.
"I don't want my case to get canceled."
"I don't want my case to get canceled."
FACT: It's common for surgeons and/or other providers to order tests to avoid potential conflict with other providers on the case, even when they themselves do not see the merit in testing. Furthermore, anesthesiologists are commonly considered the gate-keepers of canceled cases for preoperative testing; however, in one study, anesthesiologists ordered the least amount of pre-op tests compared to surgeons.
"I don't see any benefits to this."
"I don't see any benefits to this."
FACT: There are multiple benefits to reducing preoperative tests not only for the patient, but also for the clinician. Studies have shown reducing preoperative testing reduced time spent reviewing, documenting, and explaining test results that add no value and don't impact a decision regarding procedure.
"There's no harm in ordering these tests."
"There's no harm in ordering these tests."
FACT: Patients are more likely to experience undue stress and financial burden when undergoing medical tests. There is also documented evidence of patient harm when follow-up on superfluous results from preoperative testing delay care (e.g., additional falls while waiting for cataract surgery).
FACT: Patients are more likely to experience undue stress and financial burden when undergoing medical tests. There is also documented evidence of patient harm when follow-up on superfluous results from preoperative testing delay care (e.g., additional falls while waiting for cataract surgery).
"Everybody orders these tests."
"Everybody orders these tests."
FACT: Average preoperative testing rates were compared across 63 Michigan hospitals and indicated that wide variation exists both between hospitals (rates ranging from approximately 20% to over 90%) as well as within health systems for the same procedures. Norms vary between hospitals, departments, and providers.
What would you choose?
What would you choose?
Read each of the case scenarios below and choose which preoperative tests you would order for the patient. Refer to the Pre-Op Decision aid if necessary.
References:
References:
Chen CL, McLeod SD, Lietman TM, Shen H, Boscardin WJ, Chang HP, Whooley MA, Gelb AW, Lee SJ, Dudley RA. Preoperative Medical Testing and Falls in Medicare Beneficiaries Awaiting Cataract Surgery. Ophthalmology. 2021 Feb;128(2):208-215. doi: 10.1016/j.ophtha.2020.09.013. Epub 2020 Sep 11. PMID: 32926912; PMCID: PMC8443237.
Drop the Pre-Op Info Sheet: Choosing Wisely & Washington State Task Force. September 2014.
Katz RI, Dexter F, Rosenfeld K, Wolfe L, Redmond V, Agarwal D, Salik I, Goldsteen K, Goodman M, Glass PS. Survey study of anesthesiologists' and surgeons' ordering of unnecessary preoperative laboratory tests. Anesth Analg. 2011 Jan;112(1):207-12. doi: 10.1213/ANE.0b013e31820034f0. Epub 2010 Nov 16. PMID: 21081771.
Patterns and Determinants of Low-Value Preoperative Testing in Michigan.” JAMA Internal Medicine. DOI: 10.1001/jamainternmed.2021.1653
Systematic Review: Benefits and Harms of Routine Preoperative Testing: Comparative Effectiveness. Content last reviewed December 2019. Effective Health Care Program, Agency for Healthcare Research and Quality, Rockville, MD. https://effectivehealthcare.ahrq.gov/products/preoperative-testing/research
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