Preoperative Testing Could Be a Waste of Time and Money
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
"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."
- 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.