We assessed the usefulness of routine laboratory screening of preoperative patients. Computer-readable laboratory, demographic, and discharge diagnostic data were assembled for 2,000 patients undergoing elective surgery over a four-month period, and randomly selected samples of patients were studied. Several tests ordered by protocol and performed by the laboratory at the time of admission were examined in these samples, including complete blood cell count, differential cell count, prothrombin time, partial thromboplastin time, platelet count, six-factor automated multiple analysis, and glucose level. Sixty percent of these routinely ordered tests would not have been performed if testing had only been done for recognizable indications, and only 0.22% of these revealed abnormalities that might influence perioperative management. Chart review indicated that these few abnormalities were not acted on nor did they have adverse surgical or anesthetic consequences. In the absence of specific indications, routine preoperative laboratory tests contribute little to patient care and could reasonably be eliminated.

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issue of JAMA, a question regarding management of Frey's syndrome was posed.1 Additional means for treatment of the symptomatic patient include topical scopolamine cream (0.1%), commercial antiperspirants, and tympanic neurectomy.2 Antiperspirants are of only occasional value, and scopolamine cream usually affords but temporary relief because the sweat glands become refractory. Tympanic neurectomy is indicated when the gustatory sweating is severe enough to embarrass the patient.Tympanic neurectomy involves elevation of the tympanic membrane (eardrum), in order to expose the mucosa of the middle ear. Along the medial surface of the middle ear are found the autonomic secretomotor nerve fibers that normally regulate salivary secretion of the parotid gland and are responsible for gustatory sweating following parotidectomy. These fibers are disrupted, and the tympanic membrane is returned to its original position. Abolition of symptoms is usually immediate and complete following surgery. Complications are uncommon in skilled hands.