Unnecessary Preoperative Workup in Healthy Patients with Isolated Orthopedic Trauma: An Area of Healthcare Waste

Abstract

Purpose Reducing waste is at the forefront for healthcare administrators, and one area to target is routine pre-operative testing. Despite the availability of professional/societal guidelines, physicians continue to order routine preoperative tests. Preoperative tests rarely influence surgical management, and there is data supporting safety without preoperative testing in low-risk surgeries for healthy patients. We believe these principles can be extrapolated to low-risk orthopedic procedures in healthy patients, such as isolated distal extremity fractures. We believe there will be enough wasted expenditure with unnecessary preoperative workup in isolated orthopedic trauma to warrant change in preoperative management. Methods A retrospective analysis of 209 cases of isolated distal extremity fractures from July 2019-July 2020 was conducted. Charts were queried for preoperative tests completed. Each case’s respective series of preoperative tests were compared to what professional/societal guidelines deemed appropriate. A decision-making analysis was performed to assess physician overordering. Total number of unnecessary tests was calculated, and cost analysis was completed to determine potential waste. Results 98% of cases had at least one unnecessary test. Coagulation profiles and blood type tests were the most commonly over-ordered tests at 90% of the time. Cost analysis revealed $262,624 in potentially wasted expenditure. Blood type tests and chest x-rays represented the largest portion, with $129,654 and $71,694 of wasted expenditure respectively. Conclusion We recommend the implementation of multimodal interventions in clinics treating these injuries. Interventions should include components of provider education, provider audit and feedback, and EMR ordering restrictions to reduce this area of waste.