Guidelines Don't Curtail Routine Screening Before Low-Risk Surgery

Routine medical tests are still frequently performed before low-risk surgeries, despite clinical guidelines recommending against such preoperative screening.

Current guidelines do not recommend routine cardiac screening such as electrocardiograms (ECGs) and chest X-rays in patients undergoing low-risk surgery, given that evidence touted by the Choosing Wisely campaign shows these unnecessary tests often lead to surgical delays and patient anxiety.

In spite of these evidence-based guidelines, a new study published in the Canadian Medical Association Journal uncovered higher-than-expected rates of preoperative screening before low-risk procedures.

For the study, researchers examined data from more than 1.5 million patients aged 18 years and older who underwent a total of nearly 2.3 million low-risk surgical procedures between April 1, 2008, and March 31, 2013.

The research team found ECGs were performed before approximately one-third of these surgeries. Older patients were the most common recipients of preoperative tests, with ECGs conducted 18.3 times more often in those aged 66 to 75 years than those aged 18 to 25 years.

In addition to older patient age, “preoperative anesthesia and medical consultations have been shown to increase preoperative testing rates,” the study authors wrote.

“Rates of preoperative testing before low-risk procedures were higher than expected, given current guidelines and recommendations, with a significant degree of regional and institution-level variation across hospitals in a large, diverse jurisdiction with a single-payer health system,” they concluded.

In fact, they found institutions with the highest rates of ordering preoperative tests did so 30 times more frequently than facilities with the lowest rates.

The authors expressed hope that these findings may lead to changes in both provider attitudes and policies, eliminating unnecessary screening practices and allowing for more individualized patient care.

“The dramatic institution-level variation that we observed offers an opportunity for providers, administrators, and policymakers to not only explore underlying reasons for ordering tests, but also improve ordering behavior, particularly in those institutions that are significant outliers, where the impact of change may be greatest,” the researchers wrote.