Choosing Wisely:

Don’t obtain baseline laboratory studies in patients without significant systemic disease (ASA I or II) undergoing low-risk surgery–specifically complete blood count, basic or comprehensive metabolic panel, coagulation studies when blood loss (or fluid shifts) is/are expected to be minimal.

Rationale and Comments: Performing routine laboratory tests in patients who are otherwise healthy is of little value in detecting disease. Evidence suggests that a targeted history and physical exam should determine whether preprocedure laboratory studies should be obtained. The current recommendation from the 2003 ASA amendment that all female patients of childbearing age be offered pregnancy testing rather than required to undergo testing has provided individual physicians and hospitals the opportunity to set their own practices and policies relating to preoperative pregnancy testing. Some institutions respect the right of a patient to refuse testing after a thorough explanation of the anesthetic risks during pregnancy and the required signing of a waiver. The avoidance of the routine administration of the pregnancy test was therefore excluded from our top five preoperative recommendations. The risk specifically related to the surgical procedure could however modify the above preoperative recommendation to obtain laboratory studies and when the need arises; the decision to implement should include a joint decision between the anesthesiologists and surgeons. This should be applicable to all outpatient surgery.
Sponsoring Organizations:
  • American Society of Anesthesiologists
  • Sources:
  • American Society of Anesthesiologists guidelines
  • Disciplines:
  • Surgical
  • References: • Committee on Standards and Practice Parameters, Apfelbaum JL, Connis RT, Nickinovich DG; American Society of Anesthesiologists Task Force on Preanesthesia Evaluation, Pasternak LR, Arens JF, Caplan RA, Connis RT, Fleisher LA, Flowerdew R, Gold BS, Mayhew JF, Nickinovich DG, Rice LJ, Roizen MF, Twersky RS. Practice advisory for preanesthesia evaluation: an updated report by the American Society of Anesthesiologists Task Force on Preanesthesia Evaluation. Anesthesiology. 2012 Mar;116(3):522-38.
    • Kumar A, Srivastava U. Role of routine laboratory investigations in preoperative evaluation. J Anaesthesiol Clin Pharmacol. 2011;27(2):174-9.
    • Mollov JL, Twersky RS. (2013). Is routine preoperative pregnancy testing necessary? In: Fleisher L. Evidence-based practice of anesthesiology (3rd ed., pp. 26-30). Philadelphia (PA): Elsevier Saunders.
    • Soares Dde S, Brandao RR, Mourao MR, Azevedo VL, Figueiredo AV, Trindade ES. Relevance of routine testing in low risk patients undergoing minor and medium surgical procedures. Rev Bras Anestesiol. 2013;63(2):197-201.
    • Brown SR, Brown J. Why do physicians order preoperative test? A qualitative study. Fam Med. 2011;43(5):338-43.
    • Czoski-Murray C, Lloyd JM, McCabe C, Claxton K, Oluboyede Y, Roberts J, Nicholls 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 test 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;16(50):1-159.
    • Katz RI, Dexter F, Rosenfeld K, Wolfe L, Redmond V, Agarwal D, Salik I, Goldsteen K, Goodman M, Glass PS. Survey study of anesthesiologists’ and surgeons’ ordering of unnecessary preoperative laboratory tests. Anesth Analg. 2011;112(1):207-12.
    • Keay L, Lindsley K, Tielsch J, Katz J, Schein O. Routine preoperative testing for cataract surgery. Cochrane Database Syst Rev. 2012;3:CD007293.

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