Preoperative testing before low-risk surgical procedures

Abstract

) of procedures, respectively, whereas the rates of preoperative echocardiography and stress testing were 2.9% (95% CI 2.9%-2.9%) and 2.1% (95% CI 2.1%-2.1%), respectively. Significant variation was present across institutions, with the frequency of preoperative ECG ranging from 3.4% to 88.8%. Receipt of preoperative ECG and radiography were associated with older age (among patients 66-75 years of age, for ECG, adjusted odds ratio [OR] 18.3, 95% CI 17.6-19.0; for radiography, adjusted OR 2.9, 95% CI 2.8-3.0), preoperative anesthesia consultation (for ECG, adjusted OR 8.7, 95% CI 8.5-8.8; for radiography, adjusted OR 2.2, 95% CI 2.1-2.2) and preoperative medical consultation (for ECG, adjusted OR 6.8, 95% CI 6.7-6.9; for radiog raphy, adjusted OR 3.6, 95% CI 3.5-3.6). The median ORs for receipt of preoperative ECG and radiography were 2.3 and 1.6, respectively.Interpretation: Despite guideline recommendations to limit testing before low-risk surgical procedures, preoperative ECG and chest radiography were performed frequently. Significant variation across institutions remained after adjustment for patient-and institutionlevel factors. AbstractCMAJ Podcasts: author interview at soundcloud.com/cmajpodcasts/150174res

Preoperative Laboratory Investigations

“…After controlling for comorbidities and demographics, the performing ophthalmologist and preoperative consult were the largest drivers of testing variation. 34 Our study adds a number of significant elements to previous work. 7,32,33 Similar to our findings for laboratory testing, a high rate of usage and interinstitutional variability has been recently demonstrated in this population for chest x-rays and cardiac testing, including electrocardiograms, stress tests, and echocardiograms.…”

Routine use of chest x-ray for low-risk patients undergoing a periodic health examination: a retrospective cohort study

“…We also captured patient-, physician-and practice-level characteristics that have been previously associated with receipt of low-value care (Appendix 1.4 [Appendix 1]). 12,23 Demographic data were collected on both patients (age, sex, rurality) and physicians (sex, years since graduation, international medical graduate status). 12,23 Patients' socioeconomic status was approximated via quintiles of median neighbourhood income.…”

“…12,23 Demographic data were collected on both patients (age, sex, rurality) and physicians (sex, years since graduation, international medical graduate status). 12,23 Patients' socioeconomic status was approximated via quintiles of median neighbourhood income. 24 Patients with a hospital admission for a non-cardiopulmonary reason within the past 5 years were identified.…”

Safety and comparative costs of preoperative assessments for cataract surgery: traditional mandatory assessment versus a novel graded assessment system

“…[4][5][6][7][8][9][10][11][12][13] Nevertheless, recent data suggest marked variability in testing requirements between centres, and many unnecessary tests are still being performed. 14,15 Additionally, many centres have entirely eliminated preoperative assessment before cataract surgery, either for select patients or for this patient population as a whole. Furthermore, centres still conducting preoperative assessments may feel pressure to eliminate them based on historically low complication rates 4,5,10,[16][17][18] and the large volume of pending cases.…”