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Invited Commentary
August 2015

The Conundrum of Unnecessary Preoperative Testing

Author Affiliations
  • 1Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
JAMA Intern Med. 2015;175(8):1359-1361. doi:10.1001/jamainternmed.2015.2106

Old habits die hard. Physicians continue to order low-value preoperative tests that add unnecessary costs and the potential for subsequent testing that could convey risk to their patients. In 2002, the American Society of Anesthesiologists issued a practice advisory on the preanesthesia evaluation, which stated, “Preoperative tests should not be ordered routinely…preoperative tests may be ordered, required, or performed on a selective basis for purposes of guiding or optimizing perioperative management.”1(p490) Consistent with that recommendation, Macpherson and I2 reviewed the literature on the value of commonly performed preoperative tests. We found that the incidence of abnormalities that influenced management among commonly ordered preoperative tests ranged from 0% to 3% and that only abnormal findings regarding hemoglobin, electrolytes, and kidney function predicted substantially higher postoperative complication rates (positive likelihood ratio, >3.0).

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