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The case against routine preoperative laboratory testing.

Gerald W Smetana1, David S Macpherson

  • 1Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA.

The Medical Clinics of North America
|February 11, 2003
PubMed
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Routine preoperative laboratory tests often lack clinical value. Selective testing based on patient history, physical exams, and age is recommended to improve surgical care and reduce costs.

Area of Science:

  • Medical Diagnostics
  • Preoperative Medicine
  • Evidence-Based Medicine

Background:

  • Routine laboratory testing before surgery is common practice.
  • The clinical utility of many standard preoperative tests is frequently questioned.
  • Cost-effectiveness and patient benefit of universal preoperative testing are debated.

Purpose of the Study:

  • To evaluate the clinical value of routine laboratory tests in the preoperative setting.
  • To advocate for a more selective approach to preoperative test ordering.
  • To guide clinicians on appropriate preoperative test selection.

Main Methods:

  • Analysis of the clinical utility of common preoperative laboratory tests.
  • Review of guidelines and evidence supporting selective test ordering.

Related Experiment Videos

  • Emphasis on patient history and physical examination for test selection.

    • Main Results:

    • Most "routine" preoperative laboratory tests demonstrate limited clinical value.
    • Age-based testing and selective testing based on clinical findings are more effective.
    • Ordering tests only when results influence patient management is crucial.

    Conclusions:

    • Selective preoperative testing, guided by clinical assessment, is superior to routine testing for all patients.
    • Physicians should not be discouraged from selective test ordering.
    • Widespread routine preoperative testing offers no clinical benefit and incurs significant costs.