Critical assessment of routine preoperative investigations

The use of routine investigations is widespread in medical practice, particularly for preoperative assessment. Recent studies showed that some routine preoperative investigations are uninformative when ordered without a clinical indication. The rationale for preoperative investigations includes emphasis on history taking and clinical examination, as well as specific targets correlated to the surgical situation. Investigations could fall into three broad categories: discretionary tests which complete clinical history, baseline tests for interpretation of anticipated perioperative disturbances and screening tests for conditions affecting perioperative morbidity and mortality. Each investigation should answer a specific question and the result should influence decision-making. Application of these principles should lead to elimination of unnecessary tests and better utilization of medical information but further studies are needed for evaluation of such strategies.