Choosing Wisely:

Don’t perform routine preoperative testing before low-risk surgical procedures.

Rationale and Comments: Preoperative assessment is expected before all surgical procedures. This assessment includes an appropriately directed and sufficiently comprehensive history and physical examination, and, in some cases, properly includes laboratory and other testing to help direct management and assess surgical risk. However, preoperative testing for low-risk surgical procedures (such as cataract extraction) results in unnecessary delays and adds to significant avoidable costs and should be eliminated.
Sponsoring Organizations:
  • Society of General Internal Medicine
  • Sources:
  • Cochrane Database of Systematic Reviews
  • Disciplines:
  • Surgical
  • References: • Keay L, Lindsley K, Tielsch J, Katz J, Schein O. Routine preoperative medical testing for cataract surgery. Cochrane Database Syst Rev. 2012 Mar 14;3:CD007293.
    • Czoski-Murray C, Jones ML, McCabe C, Claxton K, Oluboyede Y, Roberts J, Nicholl JP, Rees A, Reilly CS, Young D, Fleming T. What is the value of routinely testing full blood count, electrolytes and urea, and pulmonary function tests before elective surgery in patients with no apparent clinical indication and in subgroups of patients with common comorbidities: a systematic review of the clinical and cost-effective literature. Health Technol Assess. 2012 Dec;16(50):1-159.
    • Fritsch G, Flamm M, Hepner DL, Panisch S, Seer J, Soennichsen A. Abnormal pre-operative tests, pathologic findings of medical history, and their predictive value for perioperative complications. Acta Anaesthesiol Scand. 2012;56(3):339-50.
    • Benarroch-Gampel J, Sheffield KM, Duncan CB, Brown KM, Han Y, Townsend CM Jr, Riall TS. Preoperative laboratory testing in patients undergoing elective, low-risk ambulatory surgery. Ann Surg. 2012 Sep;256(3):518-28.
    • Van Veen JJ. Spahn DR, Makris M. Routine preoperative coagulation tests: an outdated practice? Br J Anaesth. 2011;106:1-3.
    • Chung F, Yuan H, Yin L, Vairavanathan S, Wong DT. Elimination of preoperative testing in ambulatory surgery. Anesth Analg. 2009 Feb;108(2):467-75.
    • Apfelbaum JL, Connis RT and the Committee on Standards and Practice Parameters. Practice advisory for preanesthesia evaluation: an updated report by the American Society of Anesthesiologists Task Force on Preanesthesia Evaluation. Anesthesiology. 2012 Mar;116:522-38.

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