Practice Of Preoperative Testing Research Articles

Preoperative investigation practices for elective surgical patients: clinical audit

BackgroundThe findings of pre-operative investigations help to identify risk factors that may affect the course of surgery or post-operative recovery by contributing to informed consent conversations between the surgical team and the patient, as well as guiding surgical and anesthetic planning. Certainly, preoperative tests are valuable when they offer additional information beyond what can be gathered from a patient’s history and physical examination alone. Preoperative testing practices differ significantly among hospitals, and even within the same hospital, clinicians may have varying approaches to requesting tests. This study aimed to investigate preoperative testing practices and compare them with the latest guidelines from the National Institute for Health and Care Excellence (NICE).MethodsThis three-month institutionally based study was carried out at the Debre Tabor Comprehensive Specialized Hospital from May 1 to July 30, 2023, including individuals aged 16 years and older who were not pregnant and had undergone elective surgery in the gynecological, orthopedic, and general units. Data on the sociodemographic characteristics, the existence of comorbidities, the invasiveness of surgery, and the tests taken into consideration by the guideline were gathered using a self-administered questionnaire. After rigorously analyzing and revising the results of preoperative investigation approaches, we compared them to the standard of recommendations. Moreover, the data was analyzed and graphically presented using Microsoft Excel 2013.ResultsDuring the data collection period, 247 elective patients underwent general, orthopedic, and gynecological operations. The majority of patients, 107 (43.32%), were between the ages of 16 and 40 and had an American Society of Anesthesiologists (ASA) class one (92.71%). 350 investigations were requested in total. Of these, 71 (20.28%) tests were ordered without a justified reason or in contravention of NICE recommendations.ConclusionsIn our hospital’s surgical clinical practice, unnecessary preoperative testing is still common, especially when it comes to organ function tests, electrocardiograms (ECGs), and complete blood counts (FBCs). When deciding whether preoperative studies are required, it is critical to consider aspects including a complete patient history, a physical examination, and the invasiveness of the surgery.

Survey of ptosis practice patterns among surgeons in Asia Pacific Society of Ophthalmic Plastic and Reconstructive Surgery (APSOPRS)

ABSTRACT Objective To characterize the preferred ptosis practice patterns and variations among oculoplastic surgeons in the Asia-Pacific region. Methods A web-based questionnaire was sent to both members and non-members registered under the Asia Pacific Society of Ophthalmic Plastic and Reconstructive Surgery (APSOPRS)’s email database. The survey included preoperative testing practices, surgical preferences for adult aponeurotic and congenital ptosis, various surgical techniques (anterior and posterior approach ptosis procedures, and frontalis sling procedures) and postoperative practices. Results A total of 386 survey invitations were sent. There was a response rate of 68.7% from respondents from 20 countries in the Asia-Pacific region. There was variation in the preoperative evaluation and management of ptosis. Anterior approach ptosis surgery (96.6%) and frontalis sling procedures (86.8%) were performed by more surgeons than posterior approach ptosis surgery (47.2%). There was a deviation from the traditional frontalis sling procedures for patients with poor levator function. Conclusions Our survey results provide insight into the variation in the assessment and management of ptosis amongst oculoplastic surgeons in the Asia-Pacific region. It also demonstrates some differences between practice patterns in Asia-Pacific and America.

Variability and Costs of Low-Value Preoperative Testing for Carpal Tunnel Release Surgery.

The American Society of Anesthesiologists (ASA) Choosing Wisely Top-5 list of activities to avoid includes "Don't obtain baseline laboratory studies in patients without significant systemic disease (ASA I or II) undergoing low-risk surgery - specifically complete blood count, basic or comprehensive metabolic panel, coagulation studies when blood loss (or fluid shifts) is/are expected to be minimal." Accordingly, we define low-value preoperative tests (LVTs) as those performed before minor surgery in patients without significant systemic disease. The objective of the current study was to examine the extent, variability, drivers, and costs of LVTs before carpal tunnel release (CTR) surgeries in the US Veterans Health Administration (VHA). Using fiscal year (FY) 2015-2017 data derived from the VHA Corporate Data Warehouse (CDW), we determined the overall national and facility-level rates and associated costs of receiving any of 8 common LVTs in the 30 days before CTR in ASA physical status (PS) I-II patients. We also examined the patient, procedure, and facility factors associated with receiving ≥1 LVT with mixed-effects logistic regression and the number of tests received with mixed-effects negative binomial regression. From FY15-17, 10,000 ASA class I-II patients received a CTR by 699 surgeons in 125 VHA facilities. Overall, 47.0% of patients had a CTR that was preceded by ≥1 LVT, with substantial variability between facilities (range = 0%-100%; interquartile range = 36.3%), representing $339,717 in costs. Older age and female sex were associated with higher odds of receiving ≥1 LVT. Local versus other modes of anesthesia were associated with lower odds of receiving ≥1 LVT. Several facilities experienced large (>25%) increases or decreases from FY15 to FY17 in the proportion of patients receiving ≥1 LVT. Counter to guidance from the ASA, we found that almost half of CTRs performed on ASA class I-II VHA patients were preceded by ≥1 LVT. Although the total cost of these tests is relatively modest, CTR is just one of many low-risk procedures (eg, trigger finger release, cataract surgery) that may involve similar preoperative testing practices. These results will inform site selection for qualitative investigation of the drivers of low-value testing and the development of interventions to improve preoperative testing practice, especially in locations where rates of LVT are high.

Preoperative testing in noncardiac surgery patients

Context Previous surveys of the current practice of preoperative assessment within different countries have shown that there is much variation between different hospitals. Objective The aim of the present study was to document the current clinical practice of preoperative testing for noncardiac surgery in Europe. We also wanted to assess the opinion of anaesthesiologists on eliminating routine preoperative testing. Design Cross-sectional study. Setting Anaesthesiologists from 17 different countries in Europe were surveyed between May and July 2009. Participants Anaesthesiologists registered with a national anaesthesiology society represented in the European Society of Anaesthesiology. Main outcome measures Indications for preoperative tests in different countries within Europe. Results We received 354 completed questionnaires from 17 countries, all from different hospitals. In most countries, the anaesthesiologist has the final responsibility of performing preoperative evaluation (83%) and a preoperative assessment clinic is commonplace (95%). There is a remarkable variation in the way tests are ordered in different practices and also between different countries. About half of the anaesthesiologists indicated that they order preoperative tests in accordance with guidelines. Most respondents (86%) indicated that they would support moves towards a reduction in preoperative testing, but 44% cited patient safety as the main concern if routine testing was eliminated. Conclusion Our survey shows a large variety in organisation and practice of preoperative evaluation throughout Europe. This practice is frequently not in accordance with guideline recommendations. Our survey confirms that there is a shift towards selective testing and also that the majority of respondents support a move towards reducing preoperative testing.

Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests

BackgroundRoutine pre-operative tests for anesthesia management are often ordered by both anesthesiologists and surgeons for healthy patients undergoing low-risk surgery. The Theoretical Domains Framework (TDF) was developed to investigate determinants of behaviour and identify potential behaviour change interventions. In this study, the TDF is used to explore anaesthesiologists’ and surgeons’ perceptions of ordering routine tests for healthy patients undergoing low-risk surgery.MethodsSixteen clinicians (eleven anesthesiologists and five surgeons) throughout Ontario were recruited. An interview guide based on the TDF was developed to identify beliefs about pre-operative testing practices. Content analysis of physicians’ statements into the relevant theoretical domains was performed. Specific beliefs were identified by grouping similar utterances of the interview participants. Relevant domains were identified by noting the frequencies of the beliefs reported, presence of conflicting beliefs, and perceived influence on the performance of the behaviour under investigation.ResultsSeven of the twelve domains were identified as likely relevant to changing clinicians’ behaviour about pre-operative test ordering for anesthesia management. Key beliefs were identified within these domains including: conflicting comments about who was responsible for the test-ordering (Social/professional role and identity); inability to cancel tests ordered by fellow physicians (Beliefs about capabilities and social influences); and the problem with tests being completed before the anesthesiologists see the patient (Beliefs about capabilities and Environmental context and resources). Often, tests were ordered by an anesthesiologist based on who may be the attending anesthesiologist on the day of surgery while surgeons ordered tests they thought anesthesiologists may need (Social influences). There were also conflicting comments about the potential consequences associated with reducing testing, from negative (delay or cancel patients’ surgeries), to indifference (little or no change in patient outcomes), to positive (save money, avoid unnecessary investigations) (Beliefs about consequences). Further, while most agreed that they are motivated to reduce ordering unnecessary tests (Motivation and goals), there was still a report of a gap between their motivation and practice (Behavioural regulation).ConclusionWe identified key factors that anesthesiologists and surgeons believe influence whether they order pre-operative tests routinely for anesthesia management for a healthy adults undergoing low-risk surgery. These beliefs identify potential individual, team, and organisation targets for behaviour change interventions to reduce unnecessary routine test ordering.

Current preoperative testing practices in ambulatory surgery are widely disparate: a survey of CAS members

Routine preoperative testing has been criticized as having little impact on perioperative outcomes. The purpose of this study is to identify the current practice of preoperative testing in ambulatory surgery. A standard questionnaire was sent to all active members of the Canadian Anesthesiologists' Society (CAS). The study inquired into the anesthesiologist's preoperative testing practice in healthy patients and patients with stable medical conditions undergoing ambulatory surgery. Of 1,335 mailed questionnaires, a total 617 respondents who reported their participation in ambulatory surgical care were received. Eighty percent [95% confidence interval (CI) 76.5-83.2] of the respondents indicated that, if testing had to be ordered in asymptomatic patients undergoing low-risk ambulatory surgery, it would be due to the patient's clinical indications while others indicated it would be the result of following institutional guidelines (15.1%, 95% CI 12.2-17.9), and even fewer attributed it to a "routine" testing practice (0.5%, 95% CI 0-1.14). Forty-four percent (95% CI 39.8-47.8) of the anesthesiologists indicated that age alone is not a criterion when they required a preoperative electrocardiogram (ECG) while others reported various cut-points (> 65; > 55; > 45; > 40 yr) for ECG ordering for asymptomatic patients undergoing the low-risk ambulatory surgery. About 40% (95% CI 35.7-43.5) of the anesthesiologists had no specific concern about eliminating preoperative testing in ambulatory surgery. Our survey has documented marked disparities in the practices of preoperative testing. A large proportion of the anesthesiologists indicated that age alone is not a criterion for preoperative ordering of ECG. Many anesthesiologists had no concern about eliminating preoperative testing in low-risk ambulatory surgery.

Current pre-operative testing practices in ambulatory surgery are widely disparate: A survey of cas members

Current pre-operative testing practices in ambulatory surgery are widely disparate: A survey of cas members