title: Choosing wisely in anesthesiology: the gap between evidence and practice.
abstract: To develop a "top-five" list of unnecessary medical services in anesthesiology, we undertook a multistep survey of anesthesiologists, most of whom were in academic practice, and a consequent iterative process with the committees of the American Society of Anesthesiologists. We generated a list of 18 low-value perioperative activities from American Society of Anesthesiologists practice parameters and the literature. Starting with this list and proceeding with a 2-step survey using a 5-point Likert scale questionnaire, we eventually identified 5 common activities that are of low quality or benefit and high cost and have poor evidence supporting their use. The 2 preoperative practices in the top-five list addressed the avoidance of unindicated baseline laboratory studies or diagnostic cardiac stress testing. The 3 intraoperative practices involved the avoidance of the routine use of the pulmonary artery for cardiac surgery and the use of packed red blood cells or colloid when not indicated.
authors.affiliation: Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Onyi C
authors.initials: OC
authors.lastname: Onuoha
authors.affiliation: Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Valerie A
authors.initials: VA
authors.lastname: Arkoosh
authors.affiliation: Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Lee A
authors.initials: LA
authors.lastname: Fleisher
mesh_terms: D000776:Anesthesiology / Q000592:standards*; D003102:Colloids / Q000627:therapeutic use; D003625:Data Collection; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data; D019317:Evidence-Based Medicine / Q000379:methods*; D005080:Exercise Test / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic / Q000592:standards*; D011300:Preoperative Care / Q000592:standards
chemical_list: D003102:Colloids