Choosing Wisely:

Avoid routine preoperative testing for low-risk surgeries without a clinical indication.

Rationale and Comments: Most preoperative tests (typically a complete blood count, prothrombin time and partial thromboplastin time, basic metabolic panel, and urinalysis) performed on elective surgical patients are normal. Findings influence management in under 3% of patients tested. In almost all cases, no adverse outcomes are observed when clinically stable patients undergo elective surgery, irrespective of whether an abnormal test is identified. Preoperative testing is appropriate in symptomatic patients and those with risks factors for which diagnostic testing can provide clarification of patient surgical risk.
Sponsoring Organizations:
  • American Society for Clinical Pathology
  • Sources:
  • Cochrane Database of Systematic Reviews
  • Disciplines:
  • Surgical
  • References: • Keay L, et al. Routine preoperative medical testing for cataract surgery. Cochrane Database Syst Rev. 2012;(3):CD007293.
    • Katz R, et al. Survey study of anesthesiologists’ and surgeons’ ordering of unnecessary preoperative laboratory tests. Anesth Analg. 2011;112(1):207-12.
    • Munro J, et al. Routine preoperative testing: a systematic review of the evidence. Health Technol Assessment. 1997;1(12):i-iv, 1-62.
    • Reynolds TM. National Institute for Health and Clinical Excellence guidelines on preoperative tests: the use of routine preoperative tests for elective surgery. Ann Clin Biochem. 2006;43:13-16.
    • Capdenat Saint-Martin E, et al. Description of local adaptation of national guidelines and of active feedback for rationalizing preoperative screening in patients at low risk from anaesthetics in a French university hospital. Qual Health Care. 1998;7:5-11.

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