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Stuart CM, Bronsert MR, Meguid RA, Mott NM, Abrams BA, Dyas AR, Gleisner AL, Colborn KL, Henderson WG. The deimplementation of laboratory testing in low-risk patients as recommended by the American society of anesthesiologists: An ACS-NSQIP longitudinal analysis. World J Surg 2024; 48:1014-1024. [PMID: 38549187 DOI: 10.1002/wjs.12154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 03/08/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND In 2012, the American Society of Anesthesiologists (ASA) published guidelines recommending against routine preoperative laboratory testing for low-risk patients to reduce unnecessary medical expenditures. The aim of this study was to assess the change in routine preoperative laboratory testing in low-risk versus higher-risk patients before and after release of these guidelines. METHODS The ACS-NSQIP database, 2005-2018, was separated into low-risk versus higher-risk patients based upon a previously published stratification. The guideline implementation date was defined as January 2013. Changes in preoperative laboratory testing over time were compared between low- and higher-risk patients. A difference-in-differences model was applied. The primary outcome included any laboratory test obtained ≤90 days prior to surgery. RESULTS Of 7,507,991 patients, 972,431 (13.0%) were defined as low-risk and 6,535,560 (87.0%) higher-risk. Use of any preoperative laboratory test declined in low-risk patients from 66.5% before to 59.6% after guidelines, a 6.9 percentage point reduction, versus 93.0%-91.9% in higher-risk patients, a 1.1 percentage point reduction (p < 0.0001, comparing percentage point reductions). After risk-adjustment, the adjusted odds ratio for having any preoperative laboratory test after versus before the guidelines was 0.77 (95% CI 0.76-0.78) in low-risk versus 0.93 (0.92-0.94) in higher-risk patients. In low-risk patients, lack of any preoperative testing was not associated with worse outcomes. CONCLUSIONS While a majority of low-risk patients continue to receive preoperative laboratory testing not recommended by the ASA, there has been a decline after implementation of guidelines. Continued effort should be directed at the deimplementation of routine preoperative laboratory testing for low-risk patients.
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Affiliation(s)
- Christina M Stuart
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
- Surgical Outcomes and Applied Research, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Michael R Bronsert
- Surgical Outcomes and Applied Research, University of Colorado School of Medicine, Aurora, Colorado, USA
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Robert A Meguid
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
- Surgical Outcomes and Applied Research, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Nicole M Mott
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
- Surgical Outcomes and Applied Research, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Benjamin A Abrams
- Department of Anesthesiology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Adam R Dyas
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
- Surgical Outcomes and Applied Research, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Ana L Gleisner
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
- Surgical Outcomes and Applied Research, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Kathryn L Colborn
- Surgical Outcomes and Applied Research, University of Colorado School of Medicine, Aurora, Colorado, USA
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - William G Henderson
- Surgical Outcomes and Applied Research, University of Colorado School of Medicine, Aurora, Colorado, USA
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, Colorado, USA
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Wu L, Peng X, Zhuo X, Zhu G, Xie X. Development and Validation of a Risk-Prediction Nomogram for Preoperative Blood Type and Antibody Testing in Spinal Fusion Surgery. Orthop Surg 2024; 16:111-122. [PMID: 38044447 PMCID: PMC10782259 DOI: 10.1111/os.13946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 10/16/2023] [Accepted: 10/19/2023] [Indexed: 12/05/2023] Open
Abstract
OBJECTIVE With advancements in minimally invasive techniques, the use of spinal fusion surgery is rapidly increasing and transfusion rates are decreasing. Routine preoperative ABO/Rh blood type and antibody screening (T&S) laboratory tests may not be appropriate for all spinal fusion patients. Herein, we constructed a nomogram to assess patient transfusion risk based on various risk factors in patients undergoing spinal fusion surgery, so that preoperative T&S testing can be selectively scheduled in appropriate patients to reduce healthcare and patient costs. METHODS Patients who underwent spinal fusion surgery between 01/2020 and 03/2023 were retrospectively examined and classified into the training (n = 3533, 70%) and validation (n = 1515, 30%) datasets. LASSO and multivariable logistic regression were used to analyze risk factors for blood transfusion. Nomogram predictive model was built according to the independent predictors and mode predictive power was validated using consistency index (C-index), Hosmer-Lemeshow (HL) test, calibration curve analysis and area under the curve (AUC) for receiver operating characteristic (ROC) curve. Bootstrap resampling was used for internal validation. Decision curve analysis (DCA) was applied to evaluate the model's performance in the clinic. RESULTS Being female, age, BMI, admission route, critical patient, operative time, heart failure, end-stage renal disease or chronic kidney disease (ESRD or CKD), anemia, and coagulation defect were predictors of blood transfusion for spinal fusion. A prediction nomogram was developed according to a multivariate model with good discriminatory power (C-index = 0.887); Bootstrap resampling internal validation C-index was 0.883. Calibration curves showed strong matching between the predicted and actual probabilities of the training and validation sets. HL tests for the training and validation sets had p-values of 0.327 and 0.179, respectively, indicating good calibration. When applied to the training set, the following parameters were found: AUC: 0.895, 95% CI: 0.871-0.919, sensitivity 78.2%, specificity 86.7%, positive predictive value 29.4% and negative predictive value 98.2%. If the model were applied in the training set, 2911 T&S tests (82.4%) would be eliminated, equaling a RMB349,320 cost reduction. The AUC in the internal validation was: 0.879, 95% CI: 0.839-0.927, sensitivity 75.2%, specificity 88.8%, positive predictive value 34.3%, negative predictive value 97.9%, would eliminate 1276 T&S tests (84.2%), saving RMB 153,120. The DCA curve indicated good clinical application value. CONCLUSION The nomogram based on 10 independent factors can help healthcare professionals predict the risk of transfusion for patients undergoing spinal fusion surgery to target preoperative T&S testing to appropriate patients and reduce healthcare costs.
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Affiliation(s)
- Linghong Wu
- Guangxi Key Laboratory of Orthopaedic Biomaterials Development and Clinical TranslationLiuzhou Worker's HospitalLiuzhouChina
| | | | | | - Guangwei Zhu
- West Hospital (Orthopaedic Hospital)Liuzhou Worker's HospitalLiuzhouChina
| | - Xiangtao Xie
- Spine SurgeryLiuzhou Worker's HospitalLiuzhouChina
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Podolsky E, Hudek N, McCudden C, Presseau J, Yanikomeroglu S, Brouwers M, Brehaut JC. Choosing which in-hospital laboratory tests to target for intervention: a scoping review. Clin Chem Lab Med 2023; 61:388-401. [PMID: 36410390 PMCID: PMC9876731 DOI: 10.1515/cclm-2022-0910] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 11/03/2022] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Some laboratory testing practices may be of low value, leading to wasted resources and potential patient harm. Our scoping review investigated factors and processes that developers report using to inform decisions about what tests to target for practice improvement. METHODS We searched Medline on May 30th, 2019 and June 28th, 2021 and included guidelines, recommendation statements, or empirical studies related to test ordering practices. Studies were included if they were conducted in a tertiary care setting, reported making a choice about a specific test requiring intervention, and reported at least one factor informing that choice. We extracted descriptive details, tests chosen, processes used to make the choice, and factors guiding test choice. RESULTS From 114 eligible studies, we identified 30 factors related to test choice including clinical value, cost, prevalence of test, quality of test, and actionability of test results. We identified nine different processes used to inform decisions regarding where to spend intervention resources. CONCLUSIONS Intervention developers face difficult choices when deciding where to put scarce resources intended to improve test utilization. Factors and processes identified here can be used to inform a framework to help intervention developers make choices relevant to improving testing practices.
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Affiliation(s)
- Eyal Podolsky
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada,Clinical Epidemiology Program, Centre for Practice Changing Research, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada
| | - Natasha Hudek
- Clinical Epidemiology Program, Centre for Practice Changing Research, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada
| | - Christopher McCudden
- Clinical Epidemiology Program, Centre for Practice Changing Research, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada,Division of Biochemistry, Department of Pathology and Laboratory Medicine, The Ottawa Hospital, Ottawa, ON, Canada,Eastern Ontario Regional Laboratory Association, Ottawa, ON, Canada
| | - Justin Presseau
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada,Clinical Epidemiology Program, Centre for Practice Changing Research, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada
| | - Sezgi Yanikomeroglu
- Clinical Epidemiology Program, Centre for Practice Changing Research, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada
| | - Melissa Brouwers
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Jamie C. Brehaut
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada,Clinical Epidemiology Program, Centre for Practice Changing Research, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada
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F John J, B S Etges AP, A Z Marcolino M, D Urman R, Marques-Gomes J, A Polanczyk C. Definition of low-value care in a low-risk preoperative population: A scoping review. J Eval Clin Pract 2023; 29:639-646. [PMID: 36779241 DOI: 10.1111/jep.13812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 01/05/2023] [Accepted: 01/06/2023] [Indexed: 02/14/2023]
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.
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Affiliation(s)
- Josiane F John
- National Institute of Science and Technology for Health Technology Assessment (IATS)- CNPq/Brazil (project: 465518/2014-1), Porto Alegre, Brazil.,Graduate Program in Cardiovascular Sciences, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Ana Paula B S Etges
- National Institute of Science and Technology for Health Technology Assessment (IATS)- CNPq/Brazil (project: 465518/2014-1), Porto Alegre, Brazil.,School of Technology, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil.,Graduate Program in Epidemiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Miriam A Z Marcolino
- National Institute of Science and Technology for Health Technology Assessment (IATS)- CNPq/Brazil (project: 465518/2014-1), Porto Alegre, Brazil.,Graduate Program in Epidemiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Richard D Urman
- Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - João Marques-Gomes
- Nova School of Business and Economics, Carcavelos, Portugal.,Nova Medical School, Nova University Lisbon, Lisbon, Portugal
| | - Carisi A Polanczyk
- National Institute of Science and Technology for Health Technology Assessment (IATS)- CNPq/Brazil (project: 465518/2014-1), Porto Alegre, Brazil.,Graduate Program in Cardiovascular Sciences, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.,Graduate Program in Epidemiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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Muacevic A, Adler JR. An Economic Evaluation of the Preoperative Investigations for Elective Surgical Patients at a Caribbean Tertiary Care Teaching Hospital. Cureus 2023; 15:e33528. [PMID: 36779119 PMCID: PMC9907733 DOI: 10.7759/cureus.33528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2023] [Indexed: 01/11/2023] Open
Abstract
Introduction Preoperative assessment using widespread laboratory investigations and ancillary tests as preoperative screening may be unnecessary and lead to an economic burden. This study aimed to determine the routine preoperative investigations performed in a tertiary care teaching hospital in the Caribbean that could be categorized as unnecessary and the costs incurred for these tests. Methods Patient and surgery-specific data were collected prospectively from adult elective surgery patients over a three-month period. Surgical intensity, American Society of Anesthesiologists (ASA) grade and the National Institute for Health and Care Excellence (NICE) (UK, 2016) Clinical Guideline for Preoperative Investigations were used to determine which tests to deem unnecessary. The overall economic burden of unnecessary testing was assessed. Results Data were prospectively collected from 636 patients during the study period. Sixty-four percent of the preoperative investigations performed were deemed unnecessary. The money spent on these unnecessary investigations amounted to $44,622. When extrapolated, this can amount to approximately $178,488 per annum. This represented 59% of the total money spent on the overall preoperative investigations performed. Relatively healthier patients (ASA I and II) had a significantly higher number of unnecessary investigations performed. Conclusion This study found that the majority of preoperative investigations performed routinely may be deemed unnecessary. This results in a huge economic burden on the healthcare system. There is a need to update and strictly implement clinical guidelines for preoperative investigations.
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Horikawa H, Matsuo M, Yamazaki M. The Value of Routine Tests before Pediatric Eye Surgery: A 10-Year Experience at a Tertiary Care Hospital. Anesth Essays Res 2022; 16:392-396. [PMID: 36620119 PMCID: PMC9813999 DOI: 10.4103/aer.aer_112_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 09/09/2022] [Accepted: 09/22/2022] [Indexed: 12/13/2022] Open
Abstract
Background Routine tests before ophthalmologic surgery in adult patients are no longer recommended. However, there are limited data on the utility of routine preoperative tests for children. Aims We aimed to describe the effect of routine preoperative tests on systemic perioperative complications by hospital discharge or by day 30 following eye surgery. Settings and Design This was a single-center, observational, and descriptive study. Subjects and Methods We examined all patients ≤ 17 years old for whom ophthalmologists consulted with anesthesiologists before eye surgery under general anesthesia in an academic teaching tertiary care hospital from January 2010 to December 2019. Results A total of 708 pediatric patients were analyzed. The mean patient age was 8.5 ± 4.6 years. The most frequently performed procedure was strabismus surgery in 433 patients (61.2%). Following anesthetic consultations, 15 patients (2.1%) underwent surgery postponed due to abnormalities at the physical examination. Routine tests identified that the two patients (0.3%) required additional evaluations due to elevated serum creatine kinase and electrocardiographic abnormalities. However, further examinations found that these abnormalities were unremarkable. The remaining 691 patients (97.6%) underwent surgery as scheduled. Substantial intraoperative blood loss was observed only in three patients with malignant tumors or trauma. The incidence of systemic complications was 0 (0%; 95% confidence interval, 0%-0.05%). Conclusions These data indicated that the development of systemic perioperative complications following pediatric ophthalmic surgery is rare. Preoperative tests should be requested only if they are clinically indicated or before potentially bleeding procedures, such as malignancy or trauma surgery.
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Affiliation(s)
- Hideyo Horikawa
- Department of Anesthesiology, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Mitsuhiro Matsuo
- Department of Anesthesiology, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Mitsuaki Yamazaki
- Department of Anesthesiology, Toyama Nishi General Hospital, Toyama, Japan
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Vikas M, John K, Apruzzese P, Kendall MC, De Oliveira G. Utility of preoperative laboratory testing in ASA 1 & ASA 2 patients undergoing outpatient surgery in the United States. J Clin Anesth 2021; 76:110580. [PMID: 34794109 DOI: 10.1016/j.jclinane.2021.110580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 10/29/2021] [Accepted: 11/01/2021] [Indexed: 11/30/2022]
Abstract
STUDY OBJECTIVE To assess the utility of preoperative testing in ASA physical status 1 and 2 patients undergoing outpatient surgery across several surgical specialties. DESIGN Retrospective cohort study. PATIENTS The American College of Surgeons National Surgical Quality Improvement Program database from 2017 to 2018 was queried to extract patients defined as ASA 1 and 2 who underwent outpatient surgeries. A total of 352,775 adult patients underwent outpatient surgery with 186,954 patients had at least one lab drawn within 30 days prior to the surgery. INTERVENTIONS ASA physical status 1 and 2 patients who underwent outpatient surgeries. MEASUREMENTS The primary independent variable was the utilization of preoperative laboratory testing. The primary outcomes were the occurrence of any medical or surgical complication adverse events within 30 days of discharge. In addition, we also examined hospital readmissions. A P value of 0.025 was used to avoid type I error for each primary outcome. MAIN RESULTS In the overall cohort, 186,954 out of 352,775 (53%) of patients had at least one lab test. Hematology was the most common lab test ordered, 172,903 out of 352,755 patients (49%), followed by chemistry (43%), liver function (23%), and coagulation tests (11%). After adjusting for confounding factors, the use preoperative testing was not associated with overall medical complications, OR (95%CI) of 1.09 (1.00 to 1.18), P = 0.05 and overall surgical complications, 1.00 (0.92 to 1.08), P = 0.96 [Bonferroni corrected: medical complications OR (97.5% CI) of 1.09 (0.989 to 1.202), P = 0.0950 and overall surgical complications, 1.00 (0.918 to 1.093), P = 1.00. CONCLUSION We detected a low utility of preoperative tests for ASA 1 and 2 patients undergoing a large variety of outpatient procedures. Our results support the elimination of preoperative laboratory test for ASA 1 and 2 undergoing ambulatory surgery.
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Affiliation(s)
- Mishra Vikas
- Department of Anesthesiology, The Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Kenneth John
- Department of Anesthesiology, The Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Patricia Apruzzese
- Department of Anesthesiology, Rhode Island Hospital, Providence, RI, United States
| | - Mark C Kendall
- Department of Anesthesiology, The Warren Alpert Medical School of Brown University, Providence, RI, United States.
| | - Gildasio De Oliveira
- Department of Anesthesiology, The Warren Alpert Medical School of Brown University, Providence, RI, United States
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Matsuo M, Takemura Y, Yamazaki M. Limited Utility of Routine Tests Prior to Ophthalmologic Surgery: An Observational Study in a Japanese Hospital. JMA J 2021; 4:270-276. [PMID: 34414322 PMCID: PMC8355728 DOI: 10.31662/jmaj.2020-0112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 03/17/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction: Routine preoperative testing for low-risk surgeries without a clinical indication should be avoided; however, such tests are still frequently performed in Japan. This study was performed to assess the impact of routine preoperative tests in low-risk surgery in a Japanese medical setting. Methods: We performed a retrospective chart review to examine the utility of routine tests with respect to anesthetic management and postoperative complications in all patients aged ≥ 18 years whom ophthalmologists consulted with anesthesiologists before ophthalmologic surgery under general anesthesia. Results: During the 10-year study period, 1,234 anesthetic consultations and 1,211 routine preoperative tests (laboratory tests, chest X-rays, and electrocardiograms) were performed in Toyama University Hospital. In total, 59 patients (4.8% of the study population) canceled surgery after a battery of preoperative evaluation. Among them, 10 patients had incidental abnormalities that necessitated additional tests, and only three patients (0.2%) canceled surgery. In-hospital postoperative complications developed in nine patients (0.7%) whose routine test results made it difficult to predict development of these adverse events. No severe life-threatening events were noted in this survey. Conclusions: Routine tests prior to eye surgery for adults were of low value for perioperative management and prediction of development of in-hospital complications in this Japanese medical setting. Anesthesiologists and ophthalmologists should selectively order preoperative tests based on the medical interview and physical examination.
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Affiliation(s)
- Mitsuhiro Matsuo
- Department of Anesthesiology, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Yoshinori Takemura
- Department of Anesthesiology, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Mitsuaki Yamazaki
- Department of Anesthesiology, Faculty of Medicine, University of Toyama, Toyama, Japan
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Frakes M, Gruber J, Jena A. Is great information good enough? Evidence from physicians as patients. JOURNAL OF HEALTH ECONOMICS 2021; 75:102406. [PMID: 33310197 PMCID: PMC7855422 DOI: 10.1016/j.jhealeco.2020.102406] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 07/04/2020] [Accepted: 10/03/2020] [Indexed: 05/04/2023]
Abstract
We place an upper bound on the degree to which policies aimed at improving the information deficiencies of patients may lead to greater adherence to clinical guidelines and recommended practices. To do so, we compare the degree of adherence attained by a group of patients that should have the best possible information on health care practices-i.e., physicians as patients-with that attained by a comparable group of non-physician patients, taking various steps to account for unobservable differences between the two groups. Our results suggest that physicians, at best, do only slightly better in adhering to both low- and high-value care guidelines than non-physicians.
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Affiliation(s)
- Michael Frakes
- Duke University School of Law, 210 Science Drive, PO Box 90362, Durham, NC, 27708, United States.
| | | | - Anupam Jena
- Harvard Medical School, Massachusetts General Hospital, United States
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