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Preoperative tests still common despite recommendations to limit their use, WCH study finds

Almost one-third of patients having low-risk medical procedures in Ontario had an ECG before their procedure, and more than one in 10 had a preoperative chest X-ray, despite recommendations to limit routine use of these tests before low-risk procedures. These results from a new study by the Institute of Clinical Evaluative Sciences (ICES) and Women’s College Hospital (WCH) indicate these tests may be used more than necessary.

The study authors note that recent guidelines from Choosing Wisely Canada suggest avoiding the routine use of tests such as electrocardiograms (ECG), chest X-rays and cardiac stress tests before low-risk surgeries. The recommendation is based on research showing these tests do not improve outcomes, and may even cause delays, anxiety and unnecessary further tests.

The retrospective cohort study led by Dr. Sacha Bhatia, a cardiologist at WCH and a scientist at ICES, included 1,546,223 patients who had 2,224,070 low-risk procedures at 137 Ontario institutions between 2008 and 2013. The most common procedures were endoscopies (40 per cent) and eye surgeries (34 per cent). The rest of the procedures (26 per cent) were other low-risk surgeries such as knee surgery and hernia repair.

The study results showed that preoperative testing was common. Patients had an ECG before 31 per cent of procedures, and a chest X-ray before 11 per cent. Echocardiography was performed before three per cent of procedures, and cardiac stress testing before two per cent.

The researchers identified several factors that were associated with a higher use of pre-operative tests. These include older age, preoperative anesthesia consultations and preoperative medical consultations.

The results also showed dramatic differences between institutions in use of these tests before low-risk procedures. Usage rates for preoperative ECG ranged from 3.4 per cent to 88.8 per cent in different healthcare institutions. Rates of preoperative chest X-rays ranges from 1.6 per cent to 51 per cent. The researchers noted that these variations may represent an opportunity to address unnecessary testing at the institution level.

These findings suggest that use of preoperative tests before low-risk procedures remains common despite recommendations to limit their use.

The study was published in CMAJ on June 1, 2015.

 

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  • A publication of:
  • Women's College Hospital