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Current preoperative testing practices in ambulatory surgery are widely disparate: a survey of CAS members

  • Hongbo Yuan
  • Frances Chung
  • David Wong
  • Reginald Edward
General Anesthesia

Abstract

Purpose

Routine preoperative testing has been criticized as having little impact on perioperative outcomes. The purpose of this study is to identify the current practice of preoperative testing in ambulatory surgery.

Methods

A standard questionnaire was sent to all active members of the Canadian Anesthesiologists’ Society (CAS). The study inquired into the anesthesiologist’s preoperative testing practice in healthy patients and patients with stable medical conditions undergoing ambulatory surgery.

Results

Of 1,335 mailed questionnaires, a total 617 respondents who reported their participation in ambulatory surgical care were received. Eighty percent [95% confidence interval (CI) 76.5–83.2] of the respondents indicated that, if testing had to be ordered in asymptomatic patients undergoing low-risk ambulatory surgery, it would be due to the patient’s clinical indications while others indicated it would be the result of following institutional guidelines (15.1%, 95% CI 12.2–17.9), and even fewer attributed it to a ‘routine’ testing practice (0.5%, 95% CI 0–1.14). Forty-four percent (95% CI 39.8–47.8) of the anesthesiologists indicated that age alone is not a criterion when they required a preoperative electrocardiogram (ECG) while others reported various cut-points (> 65; > 55; > 45; > 40 yr) for ECG ordering for asymptomatic patients undergoing the low-risk ambulatory surgery. About 40% (95% CI 35.7–43.5) of the anesthesiologists had no specific concern about eliminating preoperative testing in ambulatory surgery.

Conclusion

Our survey has documented marked disparities in the practices of preoperative testing. A large proportion of the anesthesiologists indicated that age alone is not a criterion for preoperative ordering of ECG. Many anesthesiologists had no concern about eliminating preoperative testing in low-risk ambulatory surgery.

Keywords

Testing Practice Toronto Western Hospital Marked Disparity Preoperative Electrocardiogram Stable Medical Condition 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Les pratiques courantes de tests préopératoires en chirurgie ambulatoire sont grandement disparates: une enquête auprès des membres de la SCA

Résumé

Objectif

La pratique courante de tests préopératoires a été critiquée pour n’avoir que peu ďimpact sur les résultats périopératoires. Le but de notre étude est de définir la pratique courante de ces tests en chirurgie ambulatoire.

Méthode

Un questionnaire standard a été posté à tous les membres actifs de la Société canadienne des anesthésiologistes (SCA). Ľenquête a porté sur la pratique de tests préopératoires demandés par les anesthésiologistes en chirurgie ambulatoire pour des patients sains ou ďétat médical stable.

Résultats

Des I 335 anesthésiologistes sondés, 617 ont signalé leur participation à la chirurgie ambulatoire. Quatre-vingt pour cent [intervalle de confiance de 95 % (IC) 76,5–83,2] ont indiqué que si des tests devaient être faits pour des patients asymptomatiques devant subir une opération à faible risque en chirurgie ambulatoire, ils seraient guidés par les indications cliniques tandis que ďautres suivraient les lignes directrices institutionnelles (15,1 %, IC de 95 % 12,2–17,9) et peu ľattribuerait à une pratique de routine (0,5 %, IC de 95 % 0–1,14). Quarante-quatre pour cent (IC de 95 % 39,8–47,8) des anesthésiologistes ont indiqué que ľâge seul n’était pas un critère pour demander un électrocardiogramme préopératoire (ECG), mais ďautres établissaient diverses limites (> 65; > 55; > 45; > 40 ans) pour demander un ECG chez des patients asymptomatiques en chirurgie ambulatoire à faible risque. Environ 40 % (IC de 95 % 35,7–43,5) n’avaient aucun souci particulier à éliminer les tests préopératoires en chirurgie ambulatoire.

Conclusion

Notre enquête a documenté des disparités marquées dans la pratique des tests préopératoires. Une grande proportion des anesthésiologistes a indiqué que ľâge seul n’est pas un critère pour demander un ECG préopératoire. De nombreux anesthésiologistes n’avaient aucun souci à éliminer les tests préopératoires en chirurgie ambulatoire à faible risque.

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Copyright information

© Canadian Anesthesiologists 2005

Authors and Affiliations

  • Hongbo Yuan
    • 1
  • Frances Chung
    • 1
  • David Wong
    • 1
  • Reginald Edward
    • 1
  1. 1.Department of AnesthesiaToronto Western Hospital, University Health Network (UHN), University of TorontoTorontoCanada

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