Findings from a first-of-its-kind study in JAMA Internal Medicine indicate that despite recommendations from professional organizations to limit certain routine tests before elective surgery, rates of several pre-operative tests have not changed over a 14-year period.
Alana E. Sigmund, MD, from the Department of Medicine at NYU Langone Medical Center, and colleagues analyzed national data from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey from 1997–2010 on pre-operative visits at office-based physician practices, hospital-based outpatient clinics, and emergency departments in the United States. The primary outcome was changes in preoperative testing patterns following the release of two sets of guidelines, released concurrently in 2002 by the American College of Cardiology/American Heart Association and the American Society of Anesthesiologists, on appropriate testing and treatment strategies to discourage preoperative tests ordered “in absence of a specific clinical indication or purpose.”
Although overall rates of routine testing declined across several categories during the study period, after accounting for overall changes in physicians’ ordering practices these reductions were not statistically significant. The authors posit that physicians may be more likely to follow guidelines that add, rather than reduce, a test or procedure; physicians may also have not been made aware of the recommendations or may not have seen them as applicable to their patients. They also suggest that some physicians may have been influenced by reimbursement practices. To change these practices, medically-appropriate testing needs to be emphasized while physicians are still in training.
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