Low-value preoperative care in low-risk procedures: clinical and economic burden for health system sustainability

Low-value preoperative testing before low-risk surgery remains common despite strong evidence discouraging its routine use. This persistent practice generates avoidable waste and potential harm across health systems, particularly in middle-income countries where resources are limited and local evidence is scarce. The objective of this study is to evaluate preoperative care practices, associated costs, and postoperative outcomes in low-risk non-cardiac surgical procedures.

We conducted a retrospective real-world data analysis using administrative claims datasets to evaluate preoperative care in outpatient low-risk surgery reimbursed by a private payer in Brazil (mid-2018 to mid-2023). Adult patients underwent minor urological and gynaecological procedures, as well as video-laparoscopic cholecystectomy or abdominal wall hernia repair. Preoperative consultations, tests, and reimbursement fees were analysed. Primary outcomes included 30-day postoperative events: emergency visits, reinterventions, readmissions, and mortality. Preoperative tests and consultations were assessed to quantify low-value care. The Guidelines and Choosing Wisely Program were used as a reference to define low-value preoperative care. A 50% reduction was modelled to estimate the opportunity cost of reimbursable procedures.

Among 27 678 low-risk surgical procedures, at least one preoperative test was conducted in 57.5% of cases. A total of 87 709 preoperative consultations and 209 697 tests were recorded, with a median of three consultations per procedure. Overall spending on preoperative care totalled BRL 10.88 million, representing a substantial allocation of resources to services with no measurable clinical benefit in a low-risk population. A 50% reduction in potentially unnecessary services could generate savings of BRL 5.44 million, equivalent to funding over 1300 hernia repairs. Despite high testing volumes, clinical outcomes were infrequent: emergency visits occurred in 5.4% of cases, readmissions in 0.9%, reinterventions in 0.2%, and no deaths were reported.

This large real-world study shows substantial overuse of low-value preoperative services in low-risk surgery, without measurable clinical benefit, in a population with very low complication rates. Reducing unnecessary preoperative care offers a clear opportunity for both public and private healthcare organizations to improve efficiency, reduce waste, and optimize resource allocation without compromising patient safety.