Without a Clinical Indication: Preoperative Testing Despite Professional Society Guidance | Journal Scan

Study Questions:

What are preoperative testing patterns from 1997 through 2010, before and after the release of the 2002 guidance for preoperative testing from the American College of Cardiology/American Heart Association and others?


This was a retrospective analysis of nationally representative data from the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey. Adult patients who saw physicians for preoperative evaluations or general medical examinations comprised the study population. Main outcomes were physician orders for outpatient plain radiography, hematocrit, urinalysis, electrocardiogram (ECG), and cardiac stress testing. Using difference in difference (DID) regression models, the authors evaluated whether the publication of professional guidance in 2002 was associated with changes in preoperative testing patterns.


After accounting for temporal trends in routine testing, there was no statistically significant change in the use of plain radiography, hematocrit, urinalysis, or cardiac stress testing after the publication of professional guidance. Publication of the preoperative guidance was associated with a decrease in the use of ECG testing, however, which decreased by -6.7 tests per 100 visits (95% confidence interval, -10.6 to -2.7; p = 0.001).


The release of the 2002 guidance for preoperative testing was associated with a reduced incidence of routine ECG testing, but there was no change observed in plain radiography, hematocrit, urinalysis, or cardiac stress testing.


This is an important study that corroborates findings from other studies that have reported overuse of testing in the preoperative setting. Preoperative testing ordered without a clinical indication may not only be unnecessary, but may be associated with potentially harmful delays in procedures and surgeries. Future studies should seek to understand physician behavior and what factors are associated with resistance to adherence to published guidelines.

Clinical Topics: Noninvasive Imaging, Prevention, Nuclear Imaging

Keywords: Electrocardiography, Exercise Test, Guideline Adherence, Health Care Surveys, Hematocrit, Incidence, Outpatients, Preoperative Care, Radiography, Retrospective Studies, Secondary Prevention, Urinalysis

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