Some low value, high cost preoperative tests still common in U.S

A recent study from NYU Langone Medical Center finds that certain preoperative tests, which are considered of low value and high cost to some, have seen no significant changes despite peer-reviewed recommendations to change them.

Researchers saw no significant decline of the following tests, but did see a decline in pre-surgical electrocardiograms:

  • Plain radiography, or X-rays done without contrast
  • Hematocrit, or the measurement of the percentage of red blood cells
  • Urinalysis
  • Cardiac stress testing

The study looked at guidelines set by the American College of Cardiology/American Heart Association and the American Society of Anesthesiologists.

After analyzing national data, researchers also discovered overall rates of routine testing declined across a 14-year period, but the declines after accounting for changes in physicians' ordering practices were not significant.

"Evidence suggests physicians are more likely to follow guidelines that add rather than eliminate a test or procedure," said Joseph Ladapo, MD, PhD, assistant professor in the Department of Population Health at NYU Langone and the study’s senior investigator. "In addition, physicians may not have been aware of the recommendations or may not have believed they applied to their patients. They also may have been unduly influenced by reimbursement practices."

 

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