Prevalence and Factors Associated With Low-Value Preoperative Testing for Patients Undergoing Carpal Tunnel Release at an Academic Medical Center

Abstract

Background: Routine preoperative screening tests before low-risk surgery cannot be justified if the risks to patients are not outweighed by benefits. Several studies and professional guidelines suggest avoiding screening tests prior to minor operations. We aimed to assess the prevalence and patient characteristics associated with low-value preoperative tests (LVTs) prior to carpal tunnel release (CTR) at an academic medical center. Methods: From electronic medical records, we identified patients aged ≥18 who underwent CTR from 2015 to 2017. We determined the occurrence of 9 common LVTs, such as complete blood count (CBC), basic metabolic profile (BMP), and electrocardiogram (ECG), in the 30 days prior to CTR. Multivariable logistic and Poisson regression were used to identify factors associated with receiving any LVT and the number of LVTs, respectively. Results: Among 572 patients, 248 (43.4%) had at least 1 LVT. The most common tests were ECG (31.3% of CTRs), CBC (27.3% of CTRs), and BMP (23.6% of CTRs). Patient factors associated with higher odds of receiving LVT included older age, higher Elixhauser comorbidity score, and general or regional anesthesia (vs monitored anesthesia care). Conclusions: Low-value preoperative tests were frequently received by patients undergoing CTR and were associated with anesthesia type, age, and number of comorbidities. Although our study focused on CTR, these results likely have implications for other commonly performed low-risk procedures. These findings can help guide efforts to improve the quality and value of surgery for carpal tunnel syndrome and facilitate the development of strategies to reduce LVT, such as audit feedback and provider education.

Is Low-value Testing Before Low-risk Hand Surgery Associated With Increased Downstream Healthcare Use and Reimbursements? A National Claims Database Analysis

“…Preoperative screening tests in healthy patients undergoing low-risk surgery are not associated with increased surgical safety or reduced postoperative adverse events [10,29,30]. Despite the minimal benefit of such tests and the recommendation against preoperative testing, low-value tests are frequently ordered in hand surgery [15,25]. Physicians may feel compelled to order preoperative screening tests to maximize patient safety, to comply with current hospital policies/workflows, or they may be driven by the previous experience of detecting a clinically relevant finding [21,43].…”

“…We identified patients who received at least one of the following preoperative low-value tests: complete blood count, basic metabolic panel, electrocardiogram, chest radiography, pulmonary function test, and urinalysis. These screening tests were included based on previous studies analyzing the prevalence of low-value tests in low-risk hand surgery [15,25]. A test was considered preoperative if it occurred within 30 days preoperatively (Supplementary Table 4; http://links.lww.com/CORR/A818).…”

Editor’s Spotlight/Take 5: Is Low-value Testing Before Low-risk Hand Surgery Associated With Increased Downstream Healthcare Use and Reimbursements? A National Claims Database Analysis

“…You may not do hand surgery (I don't), but this study [16] is worth your attention because it covers so many important, big-picture topics. Read it, and on the way there, join me as I go behind the discovery in the Take 5 interview with its senior author, Dr. Kamal [5,8]. I think your readers probably have seen these testing requirements, and most of the time, we probably go along with these requirements as they are the gateway to treating our patients.…”

“…The motivation for this work started with somewhat arbitrary testing policies required by surgery centers, which often are based strictly on age cutoffs and not patient health. Based on this, our group had previously collaborated on work highlighting low-value testing for common hand conditions [5, 8]. I think your readers probably have seen these testing requirements, and most of the time, we probably go along with these requirements as they are the gateway to treating our patients.…”