Archive December 2002 III, No. 12

Preop Anesthesia Testing Gets Smarter

Our reader survey found that the traditional more-is-better approach to preop anesthesia testing is giving way to a more refined, efficient philosophy.

Alan Marco, MD, MMM, FACPE

BIO



Figure 1. Overall Approach
How would you characterize your overall approach to preop anesthesia testing?


3%
Standard Battery Based on Procedure Type


28.6%
Standard Battery Based on Patient's Medical Condition


5.2%
Standard Battery Based on Patient's Age


12%
Operating Physician's Preference


50.4%
Customized Panel


Not long ago, many surgeons ordered a thorough battery of preop tests even on healthy patients undergoing low-risk procedures. The intent was to minimize missed diagnoses and cancellations stemming from a lack of information. This "more-is-better" approach now appears to be going by the wayside, according to the results of an Outpatient Surgery (OS) reader poll that suggests physicians are ordering preoperative tests much more selectively.

More than 50 percent of the 133 respondents (n=67) say they or their physicians tailor preop tests to each patient's needs (Fig. 1) - with clinical condition, age, and procedure as the three most important deciding factors. This is good news, because a smart, tailored approach to determining the relevant preop tests is as safe as and less expensive than the traditional ?shotgun' approach. In fact, the American Society of Anesthesiologists (ASA) Task Force on Preanesthesia Evaluation advises against routine preop testing. One study at an orthopedic hospital showed that such a policy change reduced preop tests 30 percent and saved more than $650,000 for ambulatory orthopedic surgery patients in two years.

American Society of Anesthesiologists (ASA) Preanesthesia Testing Recommendations



  • EKG. The Task Force did not reach consensus on a minimum age for patients without risk factors but feels age alone may not be an indication. Indications may include patients with known cardiovascular risk factors or risk factors identified during preanesthesia evaluation.
  • Chest x-ray. Consider smoking, recent upper respiratory infection, COPD, and cardiac disease. However, extremes of age, smoking, stable COPD, stable cardiac disease or resolved recent upper respiratory infection are not automatic indications.
  • Hemoglobin or hematocrit. Routine H
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