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Preoperative Testing for Low Risk Patients

Preoperative diagnostic imaging and laboratory tests have little value for asymptomatic patients under-going low-risk non-cardiac surgeries. PLP examined the use of pre-op testing in Alberta to determine the frequency at which it occurs and to identify possible areas where it can be reduced or eliminated.

Current
  • Choosing Wisely
  • Anesthesiology, Family Medicine, General Surgery, Internal Medicine, Ophthalmology, Orthopedics, Urology

Choosing Wisely Recommendations

  • Don’t order baseline laboratory studies (complete blood count, coagulation testing, or serum biochemistry) for asymptomatic patients undergoing low-risk non-cardiac surgery.
  • Don’t order a baseline electrocardiogram for asymptomatic patients undergoing low-risk non-cardiac surgery.
  • Don’t order a baseline chest X-ray in asymptomatic patients, except as part of surgical or oncological evaluation.
  • Don’t perform resting echocardiography as part of preoperative assessment for asymptomatic patients undergoing low to intermediate-risk non-cardiac surgery.
  • Don’t perform cardiac stress testing for asymptomatic patients undergoing low to intermediate risk non-cardiac surgery.
Preoperative Testing in Low Risk Patients for Daycare Surgery in Calgary

Project Leads

  • Principal Investigators - Dr. Lara Cooke, Associate Dean Continuing Medical Education and Professional Development, University of Calgary
  • Co-Investigators - Dr. Shawn Dowling, Medical Director - Speciality Medicine, Physician Learning Program, University of Calgary
  • Project Manager - Ashi Mehta

Intended Outcome 

To provide physicians with knowledge of the current status of pre-operative testing in low risk patients scheduled for low risk day care surgeries in Calgary.   The results may provide further grounds to re-evaluate educational strategies about pre-operative testing.  The Surgery Strategic Clinical Network (SCN) has been engaged to help partner in such educational initiatives and change management strategies.

Background 

Traditionally, all patients scheduled for elective surgeries would be admitted to hospital often one or more days prior to their surgery so that routine investigations could be performed.  In recent times, the majority of elective surgeries are done as daycare procedures with patients coming to the hospital and discharged home the same day as the surgery.  However, the tradition of routine pre-op testing has continued in the outpatient domain.

Choosing Wisely Canada makes 4 specific recommendations from 5 different specialty societies to avoid routine pre-operative tests such as Chest X-rays, ECG’s, cardiac imaging and lab testing in those patients deemed at low risk who are scheduled for low risk surgeries.

Data Source

Sunrise Clinical Manager/Clinibase data, Calgary Laboratory Services, Diagnostic Imaging/Schedule of Medical Benefits Billing Code Data (Alberta Health)

Status: Aggregate, Calgary - wide data collection and analysis is underway and we will begin recruitment in near future

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