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Statewide trends in routine pre-operative testing before low-risk surgery.

Nicole M Mott1, Erin Kim2, Faelan Jacobson-Davies3

  • 1University of Michigan, Center for Healthcare Outcomes and Policy, Ann Arbor, MI, USA; National Clinician Scholars Program, University of Michigan, Ann Arbor, MI, USA; Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI, USA.

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Routine pre-operative testing is common before low-risk surgery, despite guidelines. Quality improvement initiatives can reduce unnecessary testing, but broader strategies are needed for lasting change.

Keywords:
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Area of Science:

  • Health Services Research
  • Surgical Outcomes
  • Quality Improvement

Background:

  • Routine pre-operative testing before low-risk surgery is prevalent, contradicting established guidelines.
  • This practice persists despite evidence suggesting it is often unnecessary for elective procedures.

Purpose of the Study:

  • To analyze trends in pre-operative testing for low-risk surgeries.
  • To identify predictors associated with pre-operative testing.
  • To evaluate the impact of a pilot quality improvement (QI) initiative on reducing testing rates.

Main Methods:

  • Retrospective cohort study of 99,501 adult patients undergoing low-risk surgeries (cholecystectomy, hernia repair, lumpectomy, thyroidectomy, mastectomy) in Michigan (2015-2024).
  • Analysis using linear mixed models to determine predictors of testing.
  • Examination of a pilot QI initiative's effect on testing rates across 31 hospitals.

Main Results:

  • Pre-operative testing rates decreased from 44% to 39% between 2019 and 2024.
  • Older age, higher comorbidity burden, and pre-operative history and physical exams were linked to increased testing.
  • Testing rates varied significantly between hospitals (13%-93%); QI initiative hospitals saw a reduction from 38% to 33% (p=0.035).

Conclusions:

  • Pre-operative testing remains a common and highly variable practice in low-risk surgical settings.
  • Quality improvement initiatives demonstrate effectiveness in reducing testing rates.
  • Sustained improvements necessitate broader de-implementation strategies beyond pilot programs.