Preoperative Testing for Urethral Sling Surgery for Stress Urinary Incontinence: Overuse, Underuse and Cost Implications.
OBJECTIVE
We identify areas of overuse and underuse in the preoperative evaluation of patients undergoing mid urethral sling surgery. We also estimate the effect of overuse of preoperative testing on health care costs.


METHODS
We conducted a retrospective review of women who underwent sling surgery with or without concomitant prolapse repair between 2012 and 2013. Physician orders for preoperative electrocardiogram, chest x-ray, basic metabolic panel, complete blood count, coagulation studies and urinalysis were classified as appropriate or inappropriate based on summary guidelines from the American Academy of Family Physicians. The additional costs of inappropriate tests were estimated using the 2014 Medicare clinical laboratory and physician fee schedules.


RESULTS
A total of 101 women who underwent mid urethral sling surgery were identified and 346 preoperative tests were ordered. Overall 76% of coagulation profiles, 73% of complete blood counts, 47% of basic metabolic panels, 39% of chest x-rays and 21% of electrocardiograms ordered did not have an appropriate clinical indication. In addition, 6% of electrocardiograms, 22% of chest x-rays and 10% of urinalyses were not ordered despite an appropriate indication. The estimated charges of overused tests were $1,844.15 for the cohort, or $18 per patient.


CONCLUSIONS
Preoperative testing is overused as well as underused in patients undergoing sling surgery. The greatest variation occurred with the use of electrocardiograms, chest x-rays and urinalysis. Poor adherence to national guidelines leads to increased health care costs and warrants increased awareness in following evidence-based guidelines.
Division of Urology, Cedars-Sinai Medical Center, Los Angeles, California.
Tom S
TS
Feng
David Geffen School of Medicine at UCLA, Los Angeles, California.
Colby E
CE
Perkins
Division of Urology, Cedars-Sinai Medical Center, Los Angeles, California.
Lauren N
LN
Wood
Division of Urology, Cedars-Sinai Medical Center, Los Angeles, California.
Karyn S
KS
Eilber
Department of Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, California.
Jerome K
JK
Wang
Cedars-Sinai Biostatistics & Bioinformatics Research Center, Los Angeles, California.
Catherine
C
Bresee
Division of Urology, Cedars-Sinai Medical Center, Los Angeles, California.
Jennifer T
JT
Anger
D000328:Adult; D000368:Aged; D003955:Diagnostic Tests, Routine / Q000191:economics* / Q000706:statistics & numerical data*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D000069342:Medical Overuse; D008875:Middle Aged; D011300:Preoperative Care / Q000191:economics* / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D053825:Suburethral Slings; D014550:Urinary Incontinence, Stress / Q000175:diagnosis* / Q000191:economics / Q000601:surgery*
health care costs; preoperative period; suburethral slings