Preoperative testing is inconsistent with published guidelines and rarely changes management.
OBJECTIVE
The Canadian Anesthesiologists' Society (CAS), the Ontario Preoperative Task Force (OPTF) and The Ottawa Hospital (TOH) have published guidelines detailing the indications for preoperative testing. The purpose of this study was to: (a) document compliance of testing practice at TOH-Civic Campus with published guidelines; and (b) determine the impact of preoperative testing on clinical management.


METHODS
Following Research Ethics approval all patients undergoing elective surgery at TOH-Civic Campus in the first three months of 2004 were identified. One hundred charts from each month were randomly selected and analyzed retrospectively by a single reviewer. The ordering and results of four preoperative tests were characterized. The indication for preoperative testing was identified from preoperative notes and the source of non-compliant orders was identified. Compliance with the CAS, OPTF, and TOH guidelines was documented. Abnormal test results were analyzed for evidence of a subsequent change in clinical management.


RESULTS
The charts of 294 of the 2,116 patients who underwent elective surgery at TOH-Civic Campus in the first three months of 2004 were reviewed. A total of 534 tests were ordered on 198 patients (67%). Non-compliance rates varied significantly (5-98%) depending on test and guideline analyzed. Results of 329 tests (61.6%) were normal. Management was changed by 14 of 534 tests ordered (2.6%). Surgery proceeded as scheduled in all cases.


CONCLUSIONS
The majority of elective surgical patients undergo preoperative testing. Non-compliance with guidelines ranged from 5 to 98%. The results of most tests were normal and influenced management in only 2.6% of cases.
Bryson
Gregory L
GL
Department of Anesthesiology, University of Ottawa, Ottawa Hospital, Ontario, Canada. glbryson@ohri.ca
Wyand
Anna
A
Bragg
Paul R
PR
D000761:Anesthesia Department, Hospital / Q000592:standards*; D003955:Diagnostic Tests, Routine / Q000592:standards / Q000706:statistics & numerical data*; D017558:Elective Surgical Procedures; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009864:Ontario; D017410:Practice Guidelines as Topic; D011300:Preoperative Care / Q000379:methods* / Q000592:standards / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014600:Utilization Review