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Preoperative testing is inconsistent with published guidelines and rarely changes management.

Gregory L Bryson1, Anna Wyand, Paul R Bragg

  • 1Department of Anesthesiology, University of Ottawa, Ottawa Hospital, Ontario, Canada. glbryson@ohri.ca

Canadian Journal of Anaesthesia = Journal Canadien D'Anesthesie
|March 11, 2006
PubMed
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Preoperative testing compliance varied widely, with most tests yielding normal results and rarely impacting surgical management. Guidelines exist but adherence is inconsistent.

Area of Science:

  • Anesthesiology
  • Surgical Care
  • Health Services Research

Background:

  • Published guidelines from the Canadian Anesthesiologists' Society (CAS), Ontario Preoperative Task Force (OPTF), and The Ottawa Hospital (TOH) outline indications for preoperative testing.
  • Preoperative testing practices are crucial for patient safety and resource allocation in elective surgery.

Purpose of the Study:

  • To assess compliance with established preoperative testing guidelines at The Ottawa Hospital-Civic Campus.
  • To evaluate the impact of preoperative testing on clinical management decisions for elective surgical patients.

Main Methods:

  • Retrospective chart review of 294 patients undergoing elective surgery over three months in 2004.
  • Analysis of 534 ordered preoperative tests, characterizing indications, compliance with guidelines (CAS, OPTF, TOH), and test result impact on management.

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Main Results:

  • Non-compliance with guidelines ranged from 5% to 98% depending on the specific test and guideline.
  • 67% of patients had tests ordered, but 61.6% of these tests had normal results.
  • Only 2.6% of ordered tests led to a change in clinical management; all surgeries proceeded as scheduled.

Conclusions:

  • A high proportion of elective surgical patients undergo preoperative testing, often with non-compliance to existing guidelines.
  • The clinical utility of many preoperative tests is low, as most results are normal and infrequently alter patient management.
  • There is a significant discrepancy between recommended preoperative testing practices and actual clinical application, with limited impact on surgical outcomes.