Adherence to evidence-based guidelines for preoperative testing in women undergoing gynecologic surgery.
OBJECTIVE
To examine adherence to evidence-based recommendations for preoperative testing and health care costs associated with excessive testing.


METHODS
An institutional review of women who underwent gynecologic surgery between 2005 and 2007 was performed. Data on the type of surgery, age, comorbidities, and perioperative testing was extracted. We noted the preoperative performance of chest X-ray, electrocardiogram, metabolic panel, complete blood count, coagulation studies, liver function tests, and urinalysis. Each test was classified as being guideline-based (appropriate) or non-guideline-based (inappropriate) as described by the National Institute of Clinical Excellence perioperative guidelines.


RESULTS
A total of 1,402 patients were identified. Ninety-five percent of patients underwent all of the guideline-recommended preoperative testing. Ninety percent of women underwent at least one nonindicated preoperative test. None of the 749 urinalyses, 407 liver function tests, or 1,046 coagulation studies performed was appropriate. Ninety-nine percent of the 427 chest X-rays ordered were inappropriate. Only 17% of metabolic panels, 36% of electrocardiograms, and 29% of complete blood counts were in accordance with evidence-based guidelines. Inappropriate perioperative tests led to a direct cost of more than $418,000. Of the inappropriate tests ordered, abnormalities were noted frequently but rarely changed management.


CONCLUSIONS
Adherence to evidence-based recommendations for preoperative testing is poor. Inappropriate preoperative tests represent a major health care expenditure.


METHODS
III.
St Clair
Caryn M
CM
From Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York.
Shah
Monjri
M
Diver
Elisabeth J
EJ
Lewin
Sharyn N
SN
Burke
William M
WM
Sun
Xuming
X
Herzog
Thomas J
TJ
Wright
Jason D
JD
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D019317:Evidence-Based Medicine / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D019983:Guideline Adherence / Q000191:economics / Q000706:statistics & numerical data*; D013509:Gynecologic Surgical Procedures; D006801:Humans; D008875:Middle Aged; D011300:Preoperative Care / Q000191:economics / Q000706:statistics & numerical data*; D055815:Young Adult