Preoperative Testing Often Unnecessary For Low-Risk Surgerie
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Patients are often required to undergo a number of tests before any surgery. Now, a recent study sheds on the futility of routine preoperative testing before low-risk surgery and how its overuse can lead to downstream care cascades involving invasive diagnostic testing. About half of patients who had one of three common surgical procedures done received at least one routine test beforehand.

Yet plenty of evidence suggests that preoperative testing is often unnecessary for low-risk surgeries. At best, it's costly and doesn't usually improve outcomes for patients. At worst, it can lead to more invasive testing and delay surgery, which can create complications that could have been avoided if the tests weren't done.

Professional organizations have identified routine preoperative testing as a low-value type of care that should be reduced whenever possible. In 2012, the American Board of Internal Medicine Foundation even launched an initiative called the Choosing Wisely campaign that promotes conversations between health care providers and patients about unnecessary medical tests and procedures.

Of about 40,000 patients in the U-M study who had surgery to either remove the gall bladder, repair a groin hernia, or remove cancerous breast tissue, close to a third underwent two or more tests beforehand, and about 13% had three or more. The most common tests were a complete blood count, an electrocardiogram and a basic metabolic panel, all of which aren't inherently necessary before these surgeries.

Patients who had a complete medical history and physical done during a visit that was separately billed were more likely to have had preoperative testing as were those who were older or had more than one medical condition. A small number of people who fall into these categories may actually benefit from having these tests done, although it's difficult to know exactly how many based on this data, the researchers say.

Yet, when they adjusted their model to account for that issue, they still found the overuse of testing. The data also revealed wide variations in testing, not only between the 63 hospitals studied but also within health systems for the same procedures, pointing to the need for more research to drill down further into the origins of the problem.