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Editorial
Less Is More
August 2, 2021

Moving Beyond Guidelines—Use of Value-Based Preoperative Testing

Author Affiliations
  • 1Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
  • 2Department of Medicine, University of California, San Francisco
  • 3Deputy Editor, JAMA Internal Medicine
JAMA Intern Med. 2021;181(11):1431-1432. doi:10.1001/jamainternmed.2021.4081

In 2010, the Institute of Medicine estimated that the annual waste in health care spending is $750 billion, with $210 billion associated with providing unnecessary services.1 Routine preoperative testing in low-risk patients has long been identified as low-value care. In this issue of JAMA Internal Medicine, Shenoy et al2 explore the prevalence and downstream effects of routine preoperative urinalysis. Guidelines from the Infectious Disease Society of America, US Preventive Services Task Force, and American Society of Anesthesiologists Task Force recommend against urine testing before procedures, with the exception of urologic procedures and prosthesis implant or when urinary tract symptoms are present.3-5 However, a retrospective analysis of preoperative tests ordered before and after the publication of the American Society of Anesthesiologists Task Force guidance in 2002 showed no change in the use of urinalysis.6 Shenoy et al2 further demonstrate that adherence to guideline-directed urinalysis testing remains low across various surgical specialties, with preoperative urinalysis performed for 25% of procedures, 84% to 94% of which were deemed inappropriate. In addition, 6% to 28% of these inappropriate urinalyses were followed by antibiotic prescriptions.2

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