WEDNESDAY, June 16, 2021 (HealthDay News) — Routine preoperative testing is common for patients undergoing low-risk surgical procedures, despite a lack of evidence that these tests offer benefit, according to a research letter published online May 17 in JAMA Internal Medicine.
Nicholas L. Berlin, M.D., M.P.H., from the University of Michigan in Ann Arbor, and colleagues conducted a retrospective cohort analysis of administrative claims data to examine the use of preoperative testing before three common low-risk ambulatory surgical procedures, assess interhospital and intrahospital variations in testing, and identify determinants of testing. In the analytic cohort, 9,619 patients underwent lumpectomy, 20,249 patients underwent laparoscopic cholecystectomy, and 10,172 patients underwent laparoscopic inguinal hernia repair.
The researchers found that 51.6, 29.4, and 13.5 percent of the patients received one or more, two or more, and three or more preoperative tests, respectively. Complete blood count, electrocardiograms, and basic metabolic panel were the three most common tests (33.1, 25.2, and 11.3 percent, respectively). Adjusting for patient case mix revealed wide interhospital and intrahospital variations in testing before the surgeries. Increasing age and comorbidities were associated with preoperative testing in multivariable models. The likelihood of undergoing testing was greater for patients who had a separately billed preoperative history and physical examination (57 versus 35 percent).
“Wide intrahospital variations in testing throughout the sample suggests that most hospitals may lack institution-wide protocols to reduce low-value testing or a centralized preoperative process and be more dependent on practice patterns of individual clinicians,” the authors write.
Several authors disclosed financial ties to the health insurance industry.
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