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

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.