Preoperative testing is inconsistent with published guidelines and rarely changes management
Abstract
Purpose The Canadian Anesthesiologists' Society (CAS), the Ontario Preoperative Task Force (OPTF) and The Ottawa Hospital (TOH) have published guidelines detailing the indications for preoperative testing. The purpose of this study was to: (a) document compliance of testing practice at TOH-Civic Campus with published guidelines; and (b) determine the impact of preoperative testing on clinical management.Methods Following Research Ethics approval all patients undergoing elective surgery at TOH-Civic Campus in the first three months of 2004 were identified. One hundred charts from each month were randomly selected and analyzed retrospectively by a single reviewer. The ordering and results of four preoperative tests were characterized. The indication for preoperative testing was identified from preoperative notes and the source of non-compliant orders was identified. Compliance with the CAS, OPTF, and TOH guidelines was documented. Abnormal test results were analyzed for evidence of a subsequent change in clinical management.Results The charts of 294 of the 2,116 patients who underwent elective surgery at TOH-Civic Campus in the first three months of 2004 were reviewed. A total of 534 tests were ordered on 198 patients (67%). Non-compliance rates varied significantly (5-98%) depending on test and guideline analyzed. Results of 329 tests (61.6%) were normal. Management was changed by 14 of 534 tests ordered (2.6%). Surgery proceeded as scheduled in all cases.Conclusion The majority of elective surgical patients undergo preoperative testing. Non-compliance with guidelines ranged from 5 to 98%. The results of most tests were normal and influenced management in only 2.6% of cases.
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Bryson reported that surgeons were responsible for 80% of the test ordering that were in non-compliance with the Ontario Pre-operative Testing Grid at the Ottawa Hospital.
“Bryson reported that surgeons were responsible for 80% of the test ordering that were in non-compliance with the Ontario Pre-operative Testing Grid at the Ottawa Hospital [10].”
The anesthesiologists and surgeons interviewed report this finding as accurate and is further supported by evidence documented by Bryson et al.
“Yet, the anesthesiologists and surgeons interviewed report this finding as accurate and is further supported by evidence documented by Bryson et al.[29].”
Bryson et al. was the only paper reviewed to suggest a need to change 'established behaviour' that should include not only anesthesiologists but surgical colleagues and clinic personnel.
“Bryson et al. was the only paper reviewed to suggest a need to change ‘established behaviour’ that should include not only anesthesiologists but surgical colleagues and clinic personnel [10].”
There has been a large body of work reporting pre-operative testing practices.
“There has been a large body of work reporting pre-operative testing practices [2,4,6,10,31-33].”
Reports continue to document unnecessary routine test ordering.
“Yet, reports continue to document unnecessary routine test ordering [2,4,6,10,31-33]”
Cites
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The Value of Routine Preoperative Medical Testing before Cataract Surgery
Schein, O. D., Katz, J., Bass, E. B., Tielsch, J. M., Lubomski, L. H., Feldman, M. A., Petty, B. G., & Steinberg, E. P. (2000) · New England Journal of Medicine · doi:10.1056/nejm200001203420304 · Cited by 526 · see citing works
Systematic review of outpatient services for chronic pain control.
McQuay, Moore, Eccleston, Morley, & Williams, A. C. D. C. (1997) · Health Technology Assessment · doi:10.3310/hta1060 · Cited by 424 · see citing works
Routine preoperative testing: a systematic review of the evidence.
Munro, J. F., Booth, A., & Nicholl, J. (1997) · Health Technology Assessment · doi:10.3310/hta1120 · Cited by 324 · see citing works
Dzankic, S., Pastor, D., González, C., & Leung, J. M. (2001) · Anesthesia & Analgesia · doi:10.1097/00000539-200108000-00013 · Cited by 210 · see citing works
Dzankic, S., Pastor, D., González, C., et al. (2001) · Anesthesia & Analgesia · doi:10.1213/00000539-200108000-00013 · Cited by 155 · see citing works
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the Canada PRIME Plus Team, Patey, A. M., Islam, R., Francis, J. J., Bryson, G. L., & Grimshaw, J. M. (2012) · Implementation Science · doi:10.1186/1748-5908-7-52 · Cited by 237 · see citing works
Self-citationElimination of Preoperative Testing in Ambulatory Surgery
Chung, F., Yuan, H., Yin, L., Vairavanathan, S., & Wong, D. T. (2009) · Anesthesia & Analgesia · doi:10.1213/ane.0b013e318176bc19 · Cited by 223 · see citing works
- Authors
- Bryson, G. L., Wyand, A., & Bragg, P. R.
- Affiliations
- University of Ottawa (CA)
- Corresponding author
- Bryson, Gregory L
- ORCID
- Bryson, Gregory L
- Venue
- Canadian Journal of Anesthesia
- Published
- 2006-03
- Volume
- 53
- Issue
- 3
- Pages
- 236-241
- ISSN
- 0832-610X (ISSN-L)
- 1496-8975
- OpenAlex
- W1514904656
- Cited by
- 136
- References
- 6
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 5 · 2023: 3 · 2022: 6 · 2021: 8 · 2020: 43 · 2019: 3 · 2018: 4 · 2017: 5 · 2016: 7 · 2015: 8 · 2014: 4 · 2013: 8 · 2012: 7
- FWCI
- 4.51
- Type
- journal article
- Language
- fr
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Canadian Journal of Anesthesia/Journal canadien d anesthésie (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Health Professions › General Health Professions › Healthcare cost, quality, practices
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac, Anesthesia and Surgical Outcomes
- Health Sciences › Medicine › Physiology › Clinical Laboratory Practices and Quality Control
- Keywords
- preoperative screening, guideline adherence, elective surgery, preoperative blood tests, clinical management change, laboratory abnormalities, Ottawa Hospital
- MeSH terms
- Anesthesia Department, Hospital, Diagnostic Tests, Routine, Female, Humans, Male, Medical Audit, Middle Aged, Ontario, Preoperative Care, Retrospective Studies, Utilization Review, Practice Guidelines as Topic, Elective Surgical Procedures, Health Care Surveys, Guideline Adherence
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