Variability and Costs of Low-Value Preoperative Testing for Cataract Surgery Within the Veterans Health Administration

Mudumbai, Seshadri C.; Pershing, Suzann; Bowe, Tom; Kamal, Robin N.; Sears, Erika D.; Hawn, Mary T.; Eisenberg, Dan; Finlay, Andrea K.; Hagedorn, Hildi; Harris, Alex H. S.

doi:10.1001/jamanetworkopen.2021.7470

Cited by 11 publications

(7 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…7 Prior investigations on the value of various preoperative testing strategies have often centered around low-risk surgery, like cataract surgery, demonstrating an absence of a morbidity and mortality benefit while incurring a marked cost to the healthcare system. 10 Although elective EVAR and open AAA repair are higher-risk surgeries than cataract surgery, the current study suggests that there are areas for value analysis surrounding preoperative stress tests prior to aortic surgery to limit costs but still providing high-quality vascular surgical care. Further studies to better delineate which patients should undergo preoperative stress testing to maximize benefit and minimize financial implications are indicated.…”

mentioning

confidence: 88%

Cardiac stress testing prior to abdominal aortic surgery: Widely variable utilization, costly, and of unclear benefit

Davis

Henke

2022

Vasc Med

View full text Add to dashboard Cite

mentioning

confidence: 88%

Cardiac stress testing prior to abdominal aortic surgery: Widely variable utilization, costly, and of unclear benefit

Davis

Henke

2022

Vasc Med

View full text Add to dashboard Cite

“…We previously found that 47.0% of generally healthy patients (ASA-PS I or II) undergoing a carpal tunnel release in the Veterans Health Administration (VA), the largest integrated healthcare system in the USA, had at least one low-value preoperative screening test within 30 days before surgery (Harris et al 2019). We also found that 49% of 50,106 cataract surgeries performed in VA in 2017 were preceded by one or more preoperative screening test with an overall annual cost of $2.6 million (Mudumbai et al 2021). In each of these studies, substantial variability existed between facilities, with some ordering almost zero tests and others routinely ordering tests for almost all patients undergoing these procedures.…”

Section: Introductionmentioning

confidence: 93%

Frequency and costs of low-value preoperative tests for patients undergoing low-risk procedures in the veterans health administration

et al. 2022

Self Cite

View full text Add to dashboard Cite

Background Clinical practice guidelines discourage routine preoperative screening tests for patients undergoing low-risk procedures. This study sought to determine the frequency and costs of potentially low-value preoperative screening tests in Veterans Health Administration (VA) patients undergoing low-risk procedures. Methods Using the VA Corporate Data Warehouse, we identified Operative Stress Score class 1 procedures (“very minor”) performed without general anesthesia in VA during fiscal year 2019 and calculated the overall national and facility-level rates and costs of nine common tests received in the 30 preoperative days. Patient factors associated with receiving at least one screening test, and the number of tests received, were examined. Results Eighty-six thousand three hundred twenty-seven of 178,775 low-risk procedures (49.3%) were preceded by 321,917 potentially low-value screening tests representing $11,505,170 using Medicare average costs. Complete blood count was the most common (33.2% of procedures), followed by basic metabolic profile (32.0%), urinalysis (26.3%), electrocardiography (18.9%), and pulmonary function test (12.4%). Older age, female sex, Black race, and having more comorbidities were associated with higher odds of low-value testing. Transthoracic echocardiogram occurred prior to only 4.5% of the procedures but accounted for 47.8% of the total costs ($5,499,860). In 129 VA facilities, the facility-level proportion of procedures preceded by at least one test ranged from 0 to 81.2% and facility-level costs ranged from $0 to $388,476. Conclusions Routine preoperative screening tests for very low-risk procedures are common and costly in some VA facilities. These results highlight a potential target to improve quality and value by reducing unnecessary care. Measures of low-value perioperative care could be integrated into VA’s extensive quality monitoring and improvement infrastructure.

show abstract

“…3,5,13,14 LVC in the preoperative setting has many gaps: there is a few studies with the types of services and/or care beyond preoperative exams that do not add value; it is unknown whether this care positively or negatively impacts clinical outcomes in patients with intermediate or high-risk surgery; the scientific evidence at this moment is not comprehensive enough for LVC in this field and this problem has seen only moderate improvements over the last few decades. 10,[13][14][15][16][17][18][19] Given this knowledge gap, a deeper understanding of how conceptual studies defined and described the consequences setting associated with LVC in preoperative of low-risk surgeries can be the first step to discuss this topic from different points of view and promote high-value care. 10,20 This scoping review seeks to identify and summarise LVC in low-risk surgeries definitions and to propose a framework with the potential consequences this care.…”

Section: Introductionmentioning

confidence: 99%

“…This period is complex and presents a variety of situations and interpretations that may or may not be considered LVC and that need to be detailed 3,5,13,14 . LVC in the preoperative setting has many gaps: there is a few studies with the types of services and/or care beyond preoperative exams that do not add value; it is unknown whether this care positively or negatively impacts clinical outcomes in patients with intermediate or high‐risk surgery; the scientific evidence at this moment is not comprehensive enough for LVC in this field and this problem has seen only moderate improvements over the last few decades 10,13‐19 …”

Section: Introductionmentioning

confidence: 99%

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

John

Etges

Marcolino

et al. 2023

Evaluation Clinical Practice

View full text Add to dashboard Cite

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.

show abstract

Variability and Costs of Low-Value Preoperative Testing for Cataract Surgery Within the Veterans Health Administration

Cited by 11 publications

References 27 publications

Cardiac stress testing prior to abdominal aortic surgery: Widely variable utilization, costly, and of unclear benefit

Cardiac stress testing prior to abdominal aortic surgery: Widely variable utilization, costly, and of unclear benefit

Frequency and costs of low-value preoperative tests for patients undergoing low-risk procedures in the veterans health administration

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

Contact Info

Product

Resources

About