Elimination of Preoperative Testing in Ambulatory Surgery
Abstract
BACKGROUND: Preoperative testing has been criticized as having little impact on perioperative outcomes. We conducted a randomized, single-blind, prospective, controlled pilot study to determine whether indicated preoperative testing can be eliminated without increasing the perioperative incidence of adverse events in selected patients undergoing ambulatory surgery. METHODS: One thousand sixty-one eligible patients were randomized either to have indicated preoperative testing or no preoperative testing. In the indicated testing group, patients received indicated preoperative testing: a complete blood count, electrolytes, blood glucose, creatinine, electrocardiogram, and chest radiograph according to the Ontario Preoperative Testing Grid as per current practice, whereas in the no testing group, no testing was ordered. The investigators, data collectors, and patient outcome reviewers were blinded to the group assignment. The primary outcome measures were the rate of perioperative adverse events and the rates of adverse events within 7 and 30 days after surgery. RESULTS: Patients' age, gender, American Society of Anesthesiologists status, type of surgery, and anesthesia were similar between the two groups. There were no significant differences in the rates of perioperative adverse events and the rates of adverse events within 30 days after surgery between the no testing group and the indicated testing group. Hospital revisits <or=7 days were higher in the indicated testing group (P < 0.05). None of the adverse events were related to the indicated testing or no testing. CONCLUSIONS: This pilot study showed that there was no increase in the perioperative adverse events as a result of no preoperative testing in our study population. A larger study is needed to demonstrate that indicated testing may be safely eliminated in selected patients undergoing ambulatory surgery without increasing perioperative complications.
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In an RCT of 1,057 ambulatory patients, there was no significant difference between rates of perioperative adverse events and rates of adverse events 30 days after surgery between patients who received pre-operative tests ordered according to the Ontario Pre-operative Testing Grid and those who received no pre-operative tests routinely ordered for anesthesia management.
“They reported no significant difference between rates of perioperative adverse events and the rates of adverse events 30 days after surgery between groups [6].”
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].”
Cites
ACC/AHA 2002 Guideline Update for Exercise Testing: Summary Article
Gibbons, R. J., Balady, G. J., Bricker, J. T., CHAITMAN, B. R., Fletcher, G. F., Froelicher, V. F., Mark, D. B., McCallister, B. D., Mooss, A. N., O’Reilly, M. G., et al. (2002) · Circulation · doi:10.1161/01.cir.0000034670.06526.15 · Cited by 2,606 · see citing works
ACC/AHA 2002 guideline update for exercise testing: summary article
Gibbons, R. J., Balady, G. J., Bricker, J. T., CHAITMAN, B. R., Fletcher, G. F., Froelicher, V. F., Mark, D. B., McCallister, B. D., Mooss, A. N., O’Reilly, M. G., et al. (2002) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(02)02164-2 · Cited by 1,231 · see citing works
Practice Advisory for Preanesthesia Evaluation
Apfelbaum, J. L., Connis, R. T., Nickinovich, D. G., Pasternak, L. R., Arens, J. F., Caplan, R. A., Connis, R. T., Fleisher, L. A., Flowerdew, R. M., Gold, B. S., et al. (2012) · Anesthesiology · doi:10.1097/aln.0b013e31823c1067 · Cited by 845 · see citing works
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
The Usefulness of Preoperative Laboratory Screening
Kaplan, E. B. (1985) · JAMA · doi:10.1001/jama.1985.03350480084025 · Cited by 498 · see citing works
Major morbidity and mortality within 1 month of ambulatory surgery and anesthesia
Warner, M. A. (1993) · JAMA · doi:10.1001/jama.270.12.1437 · Cited by 350 · see citing works
Practice Advisory for Preanesthesia Evaluation
NA (2002) · Anesthesiology · doi:10.1097/00000542-200202000-00037 · Cited by 349 · 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
Major Morbidity and Mortality Within 1 Month of Ambulatory Surgery and Anesthesia
Warner, M. A. A. (1993) · JAMA · doi:10.1001/jama.1993.03510120059031 · Cited by 281 · see citing works
The case against routine preoperative laboratory testing
Smetana, G. W., & Macpherson, D. S. (2003) · Medical Clinics of North America · doi:10.1016/s0025-7125(02)00147-5 · Cited by 239 · 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
The Value of Preoperative Screening Investigations in Otherwise Healthy Individuals
Turnbull, J. M. (1987) · Archives of Internal Medicine · doi:10.1001/archinte.1987.00370060097017 · Cited by 186 · see citing works
Return Hospital Visits and Hospital Readmissions After Ambulatory Surgery
Mezei, G., & Chung, F. F. (1999) · Annals of Surgery · doi:10.1097/00000658-199911000-00016 · Cited by 181 · see citing works
Self-citationNarr, B. J., HANSEN, T. R., & Warner, M. A. A. (1991) · Mayo Clinic Proceedings · doi:10.1016/s0025-6196(12)60487-x · Cited by 171 · 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
Dzankic, S., Pastor, D., González, C., et al. (2001) · Anesthesia & Analgesia · doi:10.1213/00000539-200108000-00013 · Cited by 155 · see citing works
More Preoperative Assessment by Physicians and Less by Laboratory Tests
Roizen, M. F. (2000) · New England Journal of Medicine · doi:10.1056/nejm200001203420311 · Cited by 146 · see citing works
Pre-existing medical conditions as predictors of adverse events in day-case surgery
Chung, F. F., Mezei, G., & Tong, D. W. (1999) · British Journal of Anaesthesia · doi:10.1093/bja/83.2.262 · Cited by 142 · see citing works
Self-citationDavis, L. E., Johnson, S., Miller‐Cribbs, J., & Saunders, J. A. (2002) · Journal of Adolescent Research · doi:10.1177/0743558402173001 · Cited by 141 · see citing works
Preoperative testing is inconsistent with published guidelines and rarely changes management
Bryson, G. L., Wyand, A., & Bragg, P. R. (2006) · Canadian Journal of Anesthesia · doi:10.1007/bf03022208 · Cited by 136 · 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
Outcomes of Patients With No Laboratory Assessment Before Anesthesia and a Surgical Procedure
Narr, B. J., Warner, M. E., Schroeder, D. R., & Warner, M. A. A. (1997) · Mayo Clinic Proceedings · doi:10.4065/72.6.505 · Cited by 119 · 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
Outcome after Day-Care Surgery in a Major Teaching Hospital
Osborne, G. A., & Rudkin, G. E. (1993) · Anaesthesia and Intensive Care · doi:10.1177/0310057x9302100613 · Cited by 101 · see citing works
Duncan, P. G., Cohen, M. M., Tweed, W. A., Biehl, D. R., Pope, W. D. B., Merchant, R. N., & DeBoer, D. P. (1992) · Canadian Journal of Anesthesia/Journal canadien d anesthésie · doi:10.1007/bf03008707 · Cited by 94 · see citing works
The Utility of Preoperative Electrocardiograms in the Ambulatory Surgical Patient
Gold, B. S. (1992) · Archives of Internal Medicine · doi:10.1001/archinte.1992.00400140055013 · Cited by 83 · see citing works
Adverse outcomes in ambulatory anesthesia
Chung, F. F., & Mezei, G. (1999) · Canadian Journal of Anesthesia/Journal canadien d anesthésie · doi:10.1007/bf03013179 · Cited by 75 · see citing works
Self-citationUsefulness of routine preoperative testing: a prospective single-observer study
Mantha, S., Roizen, M. F., Madduri, J., et al. (2005) · Journal of Clinical Anesthesia · doi:10.1016/j.jclinane.2004.04.002 · Cited by 52 · see citing works
Haug, R. H., & Reifeis, R. L. (1999) · Journal of Oral and Maxillofacial Surgery · doi:10.1016/s0278-2391(99)90623-7 · Cited by 47 · see citing works
“ROUTINE” PREOPERATIVE STUDIES
Marcello, P. W., & Roberts, P. L. (1996) · Surgical Clinics of North America · doi:10.1016/s0039-6109(05)70418-7 · Cited by 45 · see citing works
The preoperative evaluation: use the history and physical rather than routine testing.
Michota, F., & Frost, S. D. (2004) · Cleveland Clinic Journal of Medicine · doi:10.3949/ccjm.71.1.63 · Cited by 43 · see citing works
Preoperative laboratory testing: general issues and considerations
Pasternak, L. R. (2004) · Anesthesiology Clinics of North America · doi:10.1016/s0889-8537(03)00115-9 · Cited by 43 · see citing works
Imasogie, N., Wong, D. T., Luk, K., & Chung, F. (2003) · Canadian Journal of Anesthesia/Journal canadien d'anesthésie · doi:10.1007/bf03017792 · Cited by 41 · see citing works
Self-citationOlson, R. P., Stone, A., & Lubarsky, D. A. (2005) · Anesthesia & Analgesia · doi:10.1213/01.ane.0000180836.02142.e6 · Cited by 40 · see citing works
Silvestri, L. (1999) · European Journal of Anaesthesiology · doi:10.1046/j.1365-2346.1999.00577.x · Cited by 37 · see citing works
Fleisher, L. A., & Anderson, G. F. (2002) · Anesthesiology · doi:10.1097/00000542-200205000-00002 · Cited by 36 · see citing works
Ajimura, F. Y., Maia, A. S. S. F., Hachiya, A., et al. (2005) · Sao Paulo Medical Journal · doi:10.1590/s1516-31802005000200003 · Cited by 36 · see citing works
Yuan, 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
Self-citationImplementation and Evaluation of Guidelines for Preoperative Testing in a Tertiary Hospital
Greer, A. E., & Irwin, M. G. (2002) · Anaesthesia and Intensive Care · doi:10.1177/0310057x0203000310 · Cited by 26 · see citing works
Preoperative and postoperative medical evaluation of surgical patients
Gluck, R. W., Muñoz, E., & Wise, L. (1988) · The American Journal of Surgery · doi:10.1016/s0002-9610(88)80031-x · Cited by 19 · 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
- Authors
- Chung, F., Yuan, H., Yin, L., Vairavanathan, S., & Wong, D. T.
- Affiliations
- University Health Network (CA)
- Corresponding author
- Chung, Frances
- Venue
- Anesthesia & Analgesia
- Published
- 2009-02
- Volume
- 108
- Issue
- 2
- Pages
- 467-475
- ISSN
- 0003-2999 (ISSN-L)
- OpenAlex
- W1985081372
- Cited by
- 223
- References
- 40
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 11 · 2023: 5 · 2022: 7 · 2021: 9 · 2020: 8 · 2019: 8 · 2018: 23 · 2017: 17 · 2016: 18 · 2015: 15 · 2014: 17 · 2013: 19 · 2012: 18
- FWCI
- 12.29
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Anesthesia & Analgesia (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac, Anesthesia and Surgical Outcomes
- Health Sciences › Health Professions › General Health Professions › Healthcare cost, quality, practices
- Health Sciences › Medicine › Surgery › Enhanced Recovery After Surgery
- Keywords
- preoperative screening, outpatient surgery, perioperative complications, unnecessary testing, postoperative readmission, preoperative assessment
- MeSH terms
- Adolescent, Adult, Ambulatory Surgical Procedures, Data Collection, Data Interpretation, Statistical, Female, Hospitalization, Humans, Intraoperative Complications, Male, Middle Aged, Pilot Projects, Postoperative Complications, Preoperative Care, Prospective Studies, Single-Blind Method, Treatment Outcome, Young Adult
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