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Preoperative Testing Could Be a Waste of Time and Money

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Cumulatively, both groups experienced adverse events in 3% of surgeries. There was no significant difference in the number of adverse events for the testing group vs. the no-testing group. The most common events were high blood pressure and irregular heart rates. "Our study demonstrates that perioperative morbidity and morality are not reduced by routine use of commonly ordered preoperative medical tests," the authors write, adding that they "found no benefit of routine preoperative medical testing ... according to the participating center or the age, sex, or race of the patient."

While he praised the study, one prominent researcher also expressed "fear" about the possible misinterpretation of the findings. Michael F. Roizen, MD, chairman of the department of anesthesiology and critical care medicine at the University of Chicago, who wrote an editorial that was published with the study, tells WebMD he is not confident that routine physicals and medical histories are being taken or that these will be paid for if testing is abandoned.

"There has been a large body of knowledge that has created what I call a compelling rationale for less testing, but there is also the compelling message that if you are going to do less testing, you need also to have a system that ensures an adequate history and physician examination be done," Roizen says.

"Will this get done the way it ought to? I don't know," Roizen says. "Will people put up barriers to it being done right? Absolutely. Obviously, there is a complex of people who profit from more testing, and it is not in their best interest to do less testing. And there are other people, like myself, who will say you can't just stop testing."

Roizen says he also sees the findings as applicable to all minimally invasive surgeries, and perhaps a good deal of moderately invasive procedures, although "we don't have good data on moderately invasive surgeries. Hopefully, this study will allow that [research] to occur."

The federal Agency for Healthcare Research and Quality, which funded the study, will see that these findings are distributed. But beyond that, the agency can't produce guidelines itself, says Hedy Hubbard, the project manager for the cataract research.

"I think it is very compelling, and I think it should be taken seriously," Hubbard tells WebMD. "I don't think the agency is going to take a dramatic stand and say, 'Definitely, no more preoperative testing should be done.' That is dictating care, and we don't do that. We share the information; that is our role."

Vital Information:

  • In a large study of patients undergoing cataract surgery, those who underwent a series of routine, preoperative tests fared just as well as those who did not receive the tests.
  • Researchers say these results could be extended to discourage testing in many types of surgery, including those where there is little blood loss or when local anesthesia is used.
  • One expert cautions that routine physicals and medical histories are critical, if preoperative testing is going to be limited.
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