Value of routine preoperative tests: a multicentre study in four general hospitals

Area of Science:

• Anesthesiology
• Surgical Decision-Making
• Health Services Research

Background:

• Routine preoperative testing is common practice for patients undergoing elective surgery.
• The clinical utility of these tests in asymptomatic individuals remains a subject of debate.
• Evidence-based guidelines advocate for selective testing based on patient history and physical examination.

Purpose of the Study:

• To evaluate the diagnostic yield and clinical impact of routine preoperative tests in asymptomatic patients.
• To determine the influence of abnormal test results on anesthetic and surgical decisions.
• To assess the cost-effectiveness and necessity of widespread preoperative screening.

Main Methods:

• Retrospective review of medical records for 3131 ASA I and II patients undergoing elective surgery.
• Analysis of preoperative test results, including chest radiographs, electrocardiograms, biochemical, and hematological tests.
• Correlation of abnormal findings with changes in perioperative management and decision-making.

Main Results:

• 27% of patients had abnormal test results, with 15% being previously unknown and unsuspected.
• Abnormalities were most frequent in chest radiographs (8.6%), electrocardiograms (5.6%), and biochemical tests (5.6%).
• Perioperative management was altered in a very small percentage of patients (0.26-0.56%).

Conclusions:

• Routine preoperative tests in asymptomatic patients have limited value in altering anesthetic or surgical plans.
• Clinical assessment during the preanesthetic visit is crucial for guiding the selective and rational ordering of preoperative tests.
• Over-utilization of preoperative tests may not be cost-effective and can lead to unnecessary patient anxiety and further investigations.