Routine Preoperative Tests in Low-Risk Surgery. What About Adherence to Clinical Guidelines?

Abstract

In 2002, the American Heart Association guidelines established that routinary preoperative studies in low-risk patients (ASA I and II) are unnecessary. This fact has been supported by many other publications after that. However, the medical adherence to these recommendations in clinical practice is low. The aim of this review is to identify the reasons associated with a poor guideline’s adherence. Articles published between 2002 and 2022 reporting data on “preoperative test”, “routine preoperative test”, and “low-risk surgery” were identified through a computerized literature research using Pubmed, Scopus, Medigraphic and Cochrane databases and by selecting all of the articles related to adherence to clinical guidelines. The full text of relevant articles was reviewed by all authors. This review found that some of the causes of the limited adherence to clinical guidelines are: lack of awareness regarding current recommendations or lack of familiarity with them; physician attitudes about the guidelines (including outcome expectancy, lack of agreement, poor motivation to modify previous practice, question efficacy); and environmental labor factors of medical institutions, including lack of communication among the consultants involved in the perioperative care, and medicolegal concerns and fear of litigation. Hence, in order to propose effective alternatives to improve guidelines adherence, this review discuss some of the main reasons why in clinical practice there is still a poor compliance to surgical preoperative guidelines, even when more than 20 years have passed since the concept of routinary preoperative studies in low risk patients was eliminated by a myriad of clinical guidelines and medical associations.

Development and Validation of a Risk‐Prediction Nomogram for Preoperative Blood Type and Antibody Testing in Spinal Fusion Surgery

“…Routine preoperative laboratory testing may lead to more tests, consultations, and treatments that ultimately increase costs without reducing adverse events or improving outcomes. [3][4][5] Abnormal or false-positive results do not affect anesthesia or perioperative management; however, they can increase costs and patient anxiety. 6,7 In the age of value-first medicine, preoperative screening has been justified by citing concerns about patient safety and medico-legal risks, the perception that other doctors expect preoperative testing, and that the medical benefits outweigh the medical risks, thereby making them cost-effective.…”

“…In today's managed care environment with decreasing reimbursement and increasing costs, proper cost control is critical. Routine preoperative laboratory testing may lead to more tests, consultations, and treatments that ultimately increase costs without reducing adverse events or improving outcomes 3–5 . Abnormal or false‐positive results do not affect anesthesia or perioperative management; however, they can increase costs and patient anxiety 6,7 .…”