Definition of low‐value care in a low‐risk preoperative population: A scoping review

Abstract

Rationale Preoperative care is one of the main areas in which to address low‐value care. A detailed definition of what low‐value care is in this period of the surgical care journey paves the way for new scientific research, clinical improvements, and reduction of unnecessary costs in this field. Aims and Objective To identify how low‐value care in low‐risk preoperative population has been defined in the scientific literature and propose a low‐value care framework with potential consequences in this setting. Methods Scoping review of theoretical studies and peer‐reviewed papers, including reviews, commentaries, or expert opinions, were considered eligible for inclusion. The following databases were consulted: MEDLINE (via PubMed), EMBASE, and SCOPUS (from inception to July 24, 2021), using a structured search with the keywords “low value care”, “clinical waste”, “preoperative”, and “elective procedures.” Two independent reviewers performed study selection and data extraction. The definition of low‐value care in the preoperative period and their consequences were described after extracting previous low‐value care concepts and summarising the contents. Also, a visual framework was built with this information. Results From 1519 publications identified in the initial searches, 22 underwent full‐text assessment, and 11 conceptual studies were included in the review. A total of four studies (36%) presented a general low‐value care definition, and all studies report some situations considered low‐value care in the preoperative field of low‐risk surgeries. The most common example of preoperative low‐value care, listed in nine studies (81%), was having asymptomatic patients undergo screening tests before surgery. The main clinical and nonclinical consequences of low‐value care in the preoperative phase included false‐positive results from exams as well as psychological distress, increased costs, and delay in surgery. Conclusions Revisiting and integrating previous definitions of low‐value care in low‐risk surgery into a scoping review is a starting point for de‐implementing unnecessary care and promoting improvements in surgical pathways.

Can we nudge to reduce the perioperative low value care? Decision making factors influencing safe practice implementation

“…In the preoperative evaluation, it's been years since it seemed to be a consensus that routine preoperative tests in asymptomatic patients for low-risk procedures, are the most notable but modifiable source of LVC in anaesthesia in asymptomatic patients for low-risk procedures [16,17,18 ▪ ]. Still, a recent study revealed that in some institutions almost half of very minor surgical procedures performed without general anaesthesia involved at least one screening test [12 ▪ ].…”

“…Still, a recent study revealed that in some institutions almost half of very minor surgical procedures performed without general anaesthesia involved at least one screening test [12 ▪ ]. These unnecessary tests have been associated with false positives, increased costs, and delayed surgery and, in a recent scoping review of perioperative LCV definitions [18 ▪ ], it was the most frequent item found, together with unneeded hospitalization and long fasting periods in low-risk perioperative patients.…”