Routine preoperative electrocardiogram and chest x-ray prior to elective surgery in Alberta, Canada
Open accessAbstract
Purpose A study was undertaken to evaluate the utilization rates of routine preoperative electrocardiogram (ECG) and chest x-ray (CXR) by sex, age, and most frequent surgery type, and to estimate the total cost of these screening tests.Methods We included all patients undergoing elective surgery in Alberta from April 1, 2005 to March 31, 2007, except those with a cancer, trauma, or cardiac diagnosis. The utilization rate was equal to the number of tests divided by the number of elective surgeries. The total cost of the tests was estimated in Canadian dollars under a health care perspective and was equal to the number of tests multiplied by the cost per test.Results With utilization rates of 13.4% and 23.2%, routine preoperative ECG and CXR tests cost Alberta about $369,000 and $637,000 over 2 yrs, respectively. More than 80% of the cost was incurred by tests on patients aged 50 or older. The utilization rates of tests vary considerably among the most frequent surgeries, but not between men and women.Conclusions Routine preoperative testing rates and costs are relatively low in Alberta. It is possible that general evidence widely disseminated over the past number of years regarding unnecessary routines in preoperative testing has had an effect. Further interventions to reduce them would be of little value.
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Many pre-operative tests are routinely ordered for apparently healthy patients without any clinical indication, and the subsequent test results are rarely used.
“However, many pre-operative tests are routinely ordered for apparently healthy patients without any clinical indication, and the subsequent test results are rarely used [2].”
Reports continue to document unnecessary routine test ordering.
“Yet, reports continue to document unnecessary routine test ordering [2,4,6,10,31-33]”
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].”
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Cites
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
Liu, L. L., Dzankic, S., & Leung, J. M. (2002) · Journal of the American Geriatrics Society · doi:10.1046/j.1532-5415.2002.t01-1-50303.x · Cited by 164 · see citing works
The value of screening preoperative chest x-rays: a systematic review
Joo, H. S., Wong, J., Naik, V. N., & Savoldelli, G. L. (2005) · Canadian Journal of Anesthesia/Journal canadien d anesthésie · doi:10.1007/bf03015764 · Cited by 126 · see citing works
Value of routine preoperative tests: a multicentre study in four general hospitals
PEREZ, A., PLANELL, J., Bacardaz, C., Hounie, A. G., FRANCI, J., Brotons, C., CONGOST, L., & Bolíbar, I. (1995) · British Journal of Anaesthesia · doi:10.1093/bja/74.3.250 · Cited by 115 · see citing works
Finegan, B. A., Rashiq, S., McAlister, F. A., & O’Connor, P. (2005) · Canadian Journal of Anesthesia/Journal canadien d'anesthésie · doi:10.1007/bf03015765 · Cited by 76 · see citing works
Self-citationYuan, H., Chung, F. F., Wong, D. T., & Edward, R. (2005) · Canadian Journal of Anesthesia/Journal canadien d anesthésie · doi:10.1007/bf03016552 · Cited by 30 · see citing works
Central laboratory and point of care assessment of perioperative hemostasis
Siè, P., & Steib, A. (2006) · Canadian Journal of Anesthesia/Journal canadien d anesthésie · doi:10.1007/bf03022248 · Cited by 28 · see citing works
Preoperative laboratory testing: necessary or overkill?
Roizen, M. F. (2004) · Canadian Journal of Anesthesia/Journal canadien d anesthésie · doi:10.1007/bf03018343 · Cited by 13 · see citing works
Editorial I: Guidelines for routine preoperative testing
Carlisle, J. B., Langham, J., & Thoms, G. (2004) · British Journal of Anaesthesia · doi:10.1093/bja/aeh230 · Cited by 8 · see citing works
ICES Reports: Preoperative Testing Prior to Elective Surgery
Hux, J. E. (2003) · Healthcare Quarterly · doi:10.12927/hcq..16488 · Cited by 5 · see citing works
Flagged first, then by citations
Research works printed but not linked: 2
- Canadian Anesthnesiologists' Society. Guidelines to the practice of anesthesia. Can J Anesth 2006; 53: 12.
- Hux J. Preoperative testing prior to elective surgery. Hosp Q 2003; 6: 26-7.
Cited by
Sorted by citations
Evidence for overuse of medical services around the world
Brownlee, S., Chalkidou, K., Doust, J. A., Elshaug, A. G., Glasziou, P., Heath, I., Nagpal, S., Saini, V., Srivastava, D., Chalmers, K., et al. (2017) · The Lancet · doi:10.1016/s0140-6736(16)32585-5 · Cited by 1,154 · see citing works
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
Characterizing and quantifying low-value diagnostic imaging internationally: a scoping review
Kjelle, E., Andersen, E. R., Krokeide, A. M., Soril, L. J. J., van Bodegom‐Vos, L., Clement, F. M., & Hofmann, B. (2022) · BMC Medical Imaging · doi:10.1186/s12880-022-00798-2 · Cited by 100 · see citing works
Preoperative testing before low-risk surgical procedures
Kirkham, K. R., Wijeysundera, D. N., Pendrith, C., Ng, R., Tu, J. V., Laupacis, A., Schull, M. J., Levinson, W. S., & Bhatia, R. S. (2015) · Canadian Medical Association Journal · doi:10.1503/cmaj.150174 · Cited by 86 · see citing works
Gapanenko, K., Lam, D., Parker, M., D’Silva, J., & Johnson, T. (2017) · Healthcare Quarterly · doi:10.12927/hcq.2017.25295 · Cited by 46 · see citing works
Reducing unnecessary preoperative testing
Dossett, L. A., Edelman, A. L., Wilkinson, G., & Ruzycki, S. M. (2022) · BMJ · doi:10.1136/bmj-2022-070118 · Cited by 20 · see citing works
EXÁMENES PREOPERATORIOS DE RUTINA EN CIRUGÍA ELECTIVA: ¿CUÁL ES LA EVIDENCIA?
Claudio Nazar, J., Javier Bastidas, E., & Guillermo Lema, F. (2014) · Revista de Cirugía · doi:10.4067/s0718-40262014000200017 · Cited by 9 · see citing works
Wei, W., Gruebner, O., von Wyl, V., Brüngger, B., Dressel, H., Ulytė, A., Blozik, E., Bähler, C., & Schwenkglenks, M. M. (2018) · Scientific Reports · doi:10.1038/s41598-018-35856-9 · Cited by 9 · see citing works
Criteria for the request of preoperative tests among oral and maxillofacial surgeons
da Silva, L. C. F., Oliveira, A. C. D. A., Santos, J. A. S. D. S., & Santos, T. D. S. (2011) · Journal of Cranio-Maxillofacial Surgery · doi:10.1016/j.jcms.2011.10.019 · Cited by 8 · see citing works
Zarezadeh, S., Manns, B., Chew, D. S., Harrison, T. G., Au, F., & Quinn, A. E. (2023) · CMAJ Open · doi:10.9778/cmajo.20220049 · Cited by 7 · see citing works
Right-Sizing Testing Before Elective Surgery for Patients With Low Risk
Mott, N. M., Greene, D., Kim, E., Mefford, V., Cuttitta, A., Jacobson‐Davies, F. E., Smith, S. N., Kerr, E. A., Edelman, A. L., Mathis, M. R., et al. (2025) · JAMA Network Open · doi:10.1001/jamanetworkopen.2025.35750 · Cited by 4 · see citing works
Martin, M. D., González, A. H., Conejos, J. A. L., & Romero, J. L. L. (2011) · Revista Española de Anestesiología y Reanimación · doi:10.1016/s0034-9356(11)70041-x · Cited by 1 · see citing works
Utility of Electrocardiogram and Chest X-Ray for Preoperative Evaluation in Benign Hysterectomy
Shah, N. M., Keshvani, N., Das, S. R., & Kho, K. A. (2019) · Journal of Gynecologic Surgery · doi:10.1089/gyn.2018.0101 · Cited by 1 · see citing works
The Preoperative Evaluation: History, Physical Exam, and the Role of Testing
Grant, P. (2012) · Perioperative Medicine · doi:10.1002/9781118375372.ch4
Patrício, D., & Moreno, C. (2015) · Repositorio Institucional (Universidad de Cuenca)
Systematic preoperative tests prescription in elective surgery: it's high time to appraise!
Trabelsi, B., Taleb, I. B., Trifa, M., & Ali, M. B. (2022) · PubMed Central
Temporal and geographical variations of chest x-rays: A ten-year register study from Norway
Hofmann, B., Brandsæter, I. Ø., Porthun, J., & Kjelle, E. (2025) · Acta Radiologica Open · doi:10.1177/20584601251404163
Kjelle, E., Andersen, E. R., Krokeide, A. M., Soril, L. J. J., van Bodegom‐Vos, L., Clement, F. M., & Hofmann, B. (2022) · Figshare · doi:10.6084/m9.figshare.19634728
Kjelle, E., Andersen, E. R., Krokeide, A. M., Soril, L. J. J., van Bodegom‐Vos, L., Clement, F. M., & Hofmann, B. (2022) · Figshare · doi:10.6084/m9.figshare.19634725
Kjelle, E., Andersen, E. R., Krokeide, A. M., Soril, L. J. J., van Bodegom‐Vos, L., Clement, F. M., & Hofmann, B. (2022) · Figshare · doi:10.6084/m9.figshare.19634722
- Authors
- Thanh, N. X., Rashiq, S., & Jonsson, E.
- Affiliations
- University of Alberta (CA)
- Institute of Health Economics (CA)
- ORCID
- Rashiq, Saifee
- Venue
- Canadian Journal of Anesthesia/Journal canadien d'anesthésie
- Published
- 2010-01-07
- Volume
- 57
- Issue
- 2
- Pages
- 127-133
- ISSN
- 0832-610X (ISSN-L)
- 1496-8975
- OpenAlex
- W1521833936
- Cited by
- 20
- References
- 11
- Citations by year
- 2025: 2 · 2023: 1 · 2022: 6 · 2019: 1 · 2018: 1 · 2017: 2 · 2015: 2 · 2014: 1 · 2012: 2
- FWCI
- 2.27
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- 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 › Surgery › Surgical site infection prevention
- Keywords
- preoperative electrocardiogram, preoperative chest X-ray, elective surgery, health care utilization, health care costs, unnecessary testing, sex differences in testing
- MeSH terms
- Adult, Age Factors, Aged, Aged, 80 and over, Alberta, Diagnostic Tests, Routine, Electrocardiography, Female, Humans, Male, Middle Aged, Preoperative Care, Sex Factors, Radiography, Thoracic, Elective Surgical Procedures
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