Routine Preoperative Tests in Low-Risk Surgery. What About Adherence to Clinical Guidelines?
Main Article Content
Abstract
In 2002, the American Heart Association guidelines established that routinary preoperative studies in low-risk patients (ASA I and II) are unnecessary. This fact has been supported by many other publications after that. However, the medical adherence to these recommendations in clinical practice is low. The aim of this review is to identify the reasons associated with a poor guideline’s adherence.
Articles published between 2002 and 2022 reporting data on “preoperative test”, “routine preoperative test”, and “low-risk surgery” were identified through a computerized literature research using Pubmed, Scopus, Medigraphic and Cochrane databases and by selecting all of the articles related to adherence to clinical guidelines. The full text of relevant articles was reviewed by all authors.
This review found that some of the causes of the limited adherence to clinical guidelines are: lack of awareness regarding current recommendations or lack of familiarity with them; physician attitudes about the guidelines (including outcome expectancy, lack of agreement, poor motivation to modify previous practice, question efficacy); and environmental labor factors of medical institutions, including lack of communication among the consultants involved in the perioperative care, and medicolegal concerns and fear of litigation.
Hence, in order to propose effective alternatives to improve guidelines adherence, this review discuss some of the main reasons why in clinical practice there is still a poor compliance to surgical preoperative guidelines, even when more than 20 years have passed since the concept of routinary preoperative studies in low risk patients was eliminated by a myriad of clinical guidelines and medical associations.
Article Details
How to Cite
TORRES-RUIZ, María Fernanda et al.
Routine Preoperative Tests in Low-Risk Surgery. What About Adherence to Clinical Guidelines?.
Medical Research Archives, [S.l.], v. 11, n. 2, feb. 2023.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/3625>. Date accessed: 26 apr. 2024.
doi: https://doi.org/10.18103/mra.v11i2.3625.
Section
Review Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
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21. Prasad V, Cifu A, Ioannidis JPA. Reversals of established medical practices: evidence to abandon ship. JAMA. 2012;307(1):37-38. doi:10.1001/jama.2011.1960
22. Tatsioni A, Bonitsis NG, Ioannidis JPA. Persistence of contradicted claims in the literature. JAMA. 2007;298(21):2517-2526. doi:10.1001/jama.298.21.2517
23. Moscucci M. Medical reversal, clinical trials, and the “late” open artery hypothesis in acute myocardial infarction. Arch Intern Med. 2011;171(18):1643-1644. doi:10.1001/archinternmed.2011.299
24. Coleman J, Menzel H, Katz E. Social processes in physicians’ adoption of a new drug. J Chronic Dis. 1959;9(1):1-19. doi:10.1016/0021-9681(59)90134-1
25. Ries NM, Johnston B, Jansen J. A qualitative interview study of Australian physicians on defensive practice and low value care: “it’s easier to talk about our fear of lawyers than to talk about our fear of looking bad in front of each other.” BMC Med Ethics. 2022;23(1):16. doi:10.1186/s12910-022-00755-2
26. Baungaard N, Skovvang P, Assing Hvidt E, Gerbild H, Kirstine Andersen M, Lykkegaard J. How defensive medicine is defined and understood in European medical literature: protocol for a systematic review. BMJ Open. 2020;10(2):e034300. doi:10.1136/bmjopen-2019-034300
27. American Society of Anesthesiologists Task Force on Preanesthesia Evaluation. Practice advisory for preanesthesia evaluation: a report by the American Society of Anesthesiologists Task Force on Preanesthesia Evaluation. Anesthesiology. 2002;96(2):485-496. doi:10.1097/00000542-200202000-00037
28. Mantha S, Roizen MF, Madduri J, Rajender Y, Shanti Naidu K, Gayatri K. Usefulness of routine preoperative testing: a prospective single-observer study. J Clin Anesth. 2005;17(1):51-57. doi:10.1016/j.jclinane.2004.04.002
29. Rizan C, Reed M, Mortimer F, Jones A, Stancliffe R, Bhutta M. Using surgical sustainability principles to improve planetary health and optimise surgical services following the COVID-19 pandemic. Bull R Coll Surg Engl. 2020;102(5):177-181. doi:10.1308/rcsbull.2020.148
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32. Sirovich BE, Woloshin S, Schwartz LM. Too Little? Too Much? Primary Care Physicians’ Views on US Health Care. Arch Intern Med. 2011;171(17):1582-1585. doi:10.1001/archinternmed.2011.437
33. Torres-Ruiz MF, Cárdenas-Lailson LE, Quiróz-Villegas ME, Bravo-León J. [A standard questionnaire to reduce the routine battery of preoperative tests for elective surgery]. Cir Cir. 2014;82(5):517-527.
34. Flamm M, Fritsch G, Hysek M, et al. Quality improvement in preoperative assessment by implementation of an electronic decision support tool. J Am Med Inform Assoc. 2013;20(e1):e91-e96. doi:10.1136/amiajnl-2012-001178
35. Suria S, Harkouk H, Eghiaian A, Weil G. How to rationalize preoperative tests? A method to implement local guidelines successfully. Anaesth Crit Care Pain Med. 2016;35(2):103-107. doi:10.1016/j.accpm.2015.10.004
36. Choosing Wisely. Published October 24, 2014. Accessed January 19, 2023. https://www.choosingwisely.org/
37. History. Published October 29, 2014. Accessed January 19, 2023. https://www.choosingwisely.org/our-mission/history/
38. Bainbridge D, Martin J, Arango M, Cheng D. Perioperative and anaesthetic-related mortality in developed and developing countries: a systematic review and meta-analysis. The Lancet. 2012;380(9847):1075-1081. doi:10.1016/S0140-6736(12)60990-8
39. Bordes J, Cungi PJ, Savoie PH, Bonnet S, Kaiser E. Usefulness of routine preoperative testing in a developing country: a prospective study. Pan Afr Med J. 2015;21. doi:10.11604/pamj.2015.21.94.5860
40. Pal KM, Khan IA, Safdar B. Preoperative work up: are the requirements different in a developing country? JPMA J Pak Med Assoc. 1998;48(11):339-341.
41. Grubert TA, Reindell D, Kästner R, et al. Rates of postoperative complications among human immunodeficiency virus-infected women who have undergone obstetric and gynecologic surgical procedures. Clin Infect Dis Off Publ Infect Dis Soc Am. 2002;34(6):822-830. doi:10.1086/339043
42. Oodit R, Biccard BM, Panieri E, et al. Guidelines for Perioperative Care in Elective Abdominal and Pelvic Surgery at Primary and Secondary Hospitals in Low–Middle-Income Countries (LMIC’s): Enhanced Recovery After Surgery (ERAS) Society Recommendation. World J Surg. 2022;46(8):1826-1843. doi:10.1007/s00268-022-06587-w
43. George T. Semi-Structured Interview | Definition, Guide & Examples. Scribbr. Published May 4, 2022. Accessed January 16, 2023. https://www.scribbr.co.uk/research-methods/semi-structured-interviews/
2. Edwards AF, Forest DJ. Preoperative Laboratory Testing. Anesthesiol Clin. 2018;36(4):493-507. doi:10.1016/j.anclin.2018.07.002
3. Brateanu A, Rothberg MB. Why do clinicians continue to order ‘routine preoperative tests’ despite the evidence? Cleve Clin J Med. 2015;82(10):667-670. doi:10.3949/ccjm.82a.15118
4. Fleisher LA, Fleischmann KE, Auerbach AD, et al. 2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;130(24). doi:10.1161/CIR.0000000000000106
5. Halvorsen S, Mehilli J, Cassese S, et al. 2022 ESC Guidelines on cardiovascular assessment and management of patients undergoing non-cardiac surgery. Eur Heart J. 2022;43(39):3826-3924. doi:10.1093/eurheartj/ehac270
6. De Hert S, Staender S, Fritsch G, et al. Pre-operative evaluation of adults undergoing elective noncardiac surgery: Updated guideline from the European Society of Anaesthesiology. Eur J Anaesthesiol. 2018;35(6):407-465. doi:10.1097/EJA.0000000000000817
7. National Institute for Clinical Excellence. Preoperative test (update). Routine preoperative tests for elective surgery. Published 2016. Accessed December 14, 2022. https://www.nice.org.uk/guidance/ng45
8. Jacobs AK, Anderson JL, Halperin JL, et al. The evolution and future of ACC/AHA clinical practice guidelines: a 30-year journey: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines. Circulation. 2014;130(14):1208-1217. doi:10.1161/CIR.0000000000000090
9. Guyatt GH, Oxman AD, Kunz R, et al. GRADE guidelines: 2. Framing the question and deciding on important outcomes. J Clin Epidemiol. 2011;64(4):395-400. doi:10.1016/j.jclinepi.2010.09.012
10. Rusk MH. Avoiding Unnecessary Preoperative Testing. Med Clin North Am. 2016;100(5):1003-1008. doi:10.1016/j.mcna.2016.04.011
11. Kumar A, Srivastava U. Role of routine laboratory investigations in preoperative evaluation. J Anaesthesiol Clin Pharmacol. 2011;27(2):174. doi:10.4103/0970-9185.81824
12. Siddaiah H, Patil S, Shelvan A, et al. Preoperative laboratory testing: Implications of “Choosing Wisely” guidelines. Best Pract Res Clin Anaesthesiol. 2020;34(2):303-314. doi:10.1016/j.bpa.2020.04.006
13. Keay L, Lindsley K, Tielsch J, Katz J, Schein O. Routine preoperative medical testing for cataract surgery. Cochrane Eyes and Vision Group, ed. Cochrane Database Syst Rev. 2019;2019(1). doi:10.1002/14651858.CD007293.pub4
14. Hand WR, Bridges KH, Stiegler MP, et al. Effect of a Cognitive Aid on Adherence to Perioperative Assessment and Management Guidelines for the Cardiac Evaluation of Noncardiac Surgical Patients. Anesthesiology. 2014;120(6):1339-1353. doi:10.1097/ALN.0000000000000251
15. Taylor GA, Oresanya LB, Kling SM, et al. Rethinking the routine: Preoperative laboratory testing among American Society of Anesthesiologists class 1 and 2 patients before low-risk ambulatory surgery in the 2017 National Surgical Quality Improvement Program cohort. Surgery. 2022;171(2):267-274. doi:10.1016/j.surg.2021.07.036
16. Cabana MD, Rand CS, Powe NR, et al. Why don’t physicians follow clinical practice guidelines? A framework for improvement. JAMA. 1999;282(15):1458-1465. doi:10.1001/jama.282.15.1458
17. Shahid R, Chaya M, Lutz I, Taylor B, Xiao L, Groot G. Exploration of a quality improvement process to standardised preoperative tests for a surgical procedure to reduce waste. BMJ Open Qual. 2021;10(3):e001570. doi:10.1136/bmjoq-2021-001570
18. Brown SR, Brown J. Why do physicians order unnecessary preoperative tests? A qualitative study. Fam Med. 2011;43(5):338-343.
19. Patey AM, Islam R, Francis JJ, Bryson GL, Grimshaw JM, Canada PRIME Plus Team. Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests. Implement Sci IS. 2012;7:52. doi:10.1186/1748-5908-7-52
20. Katz RI, Dexter F, Rosenfeld K, et al. Survey study of anesthesiologists’ and surgeons’ ordering of unnecessary preoperative laboratory tests. Anesth Analg. 2011;112(1):207-212. doi:10.1213/ANE.0b013e31820034f0
21. Prasad V, Cifu A, Ioannidis JPA. Reversals of established medical practices: evidence to abandon ship. JAMA. 2012;307(1):37-38. doi:10.1001/jama.2011.1960
22. Tatsioni A, Bonitsis NG, Ioannidis JPA. Persistence of contradicted claims in the literature. JAMA. 2007;298(21):2517-2526. doi:10.1001/jama.298.21.2517
23. Moscucci M. Medical reversal, clinical trials, and the “late” open artery hypothesis in acute myocardial infarction. Arch Intern Med. 2011;171(18):1643-1644. doi:10.1001/archinternmed.2011.299
24. Coleman J, Menzel H, Katz E. Social processes in physicians’ adoption of a new drug. J Chronic Dis. 1959;9(1):1-19. doi:10.1016/0021-9681(59)90134-1
25. Ries NM, Johnston B, Jansen J. A qualitative interview study of Australian physicians on defensive practice and low value care: “it’s easier to talk about our fear of lawyers than to talk about our fear of looking bad in front of each other.” BMC Med Ethics. 2022;23(1):16. doi:10.1186/s12910-022-00755-2
26. Baungaard N, Skovvang P, Assing Hvidt E, Gerbild H, Kirstine Andersen M, Lykkegaard J. How defensive medicine is defined and understood in European medical literature: protocol for a systematic review. BMJ Open. 2020;10(2):e034300. doi:10.1136/bmjopen-2019-034300
27. American Society of Anesthesiologists Task Force on Preanesthesia Evaluation. Practice advisory for preanesthesia evaluation: a report by the American Society of Anesthesiologists Task Force on Preanesthesia Evaluation. Anesthesiology. 2002;96(2):485-496. doi:10.1097/00000542-200202000-00037
28. Mantha S, Roizen MF, Madduri J, Rajender Y, Shanti Naidu K, Gayatri K. Usefulness of routine preoperative testing: a prospective single-observer study. J Clin Anesth. 2005;17(1):51-57. doi:10.1016/j.jclinane.2004.04.002
29. Rizan C, Reed M, Mortimer F, Jones A, Stancliffe R, Bhutta M. Using surgical sustainability principles to improve planetary health and optimise surgical services following the COVID-19 pandemic. Bull R Coll Surg Engl. 2020;102(5):177-181. doi:10.1308/rcsbull.2020.148
30. Hospitals race to save patients — and the planet. AAMC. Accessed January 17, 2023. https://www.aamc.org/news-insights/hospitals-race-save-patients-and-planet
31. Reducing the Environmental Impact of Clinical Laboratories - PMC. Accessed January 17, 2023. https://www-ncbi-nlm-nih-gov.pbidi.unam.mx:2443/pmc/articles/PMC5548370/
32. Sirovich BE, Woloshin S, Schwartz LM. Too Little? Too Much? Primary Care Physicians’ Views on US Health Care. Arch Intern Med. 2011;171(17):1582-1585. doi:10.1001/archinternmed.2011.437
33. Torres-Ruiz MF, Cárdenas-Lailson LE, Quiróz-Villegas ME, Bravo-León J. [A standard questionnaire to reduce the routine battery of preoperative tests for elective surgery]. Cir Cir. 2014;82(5):517-527.
34. Flamm M, Fritsch G, Hysek M, et al. Quality improvement in preoperative assessment by implementation of an electronic decision support tool. J Am Med Inform Assoc. 2013;20(e1):e91-e96. doi:10.1136/amiajnl-2012-001178
35. Suria S, Harkouk H, Eghiaian A, Weil G. How to rationalize preoperative tests? A method to implement local guidelines successfully. Anaesth Crit Care Pain Med. 2016;35(2):103-107. doi:10.1016/j.accpm.2015.10.004
36. Choosing Wisely. Published October 24, 2014. Accessed January 19, 2023. https://www.choosingwisely.org/
37. History. Published October 29, 2014. Accessed January 19, 2023. https://www.choosingwisely.org/our-mission/history/
38. Bainbridge D, Martin J, Arango M, Cheng D. Perioperative and anaesthetic-related mortality in developed and developing countries: a systematic review and meta-analysis. The Lancet. 2012;380(9847):1075-1081. doi:10.1016/S0140-6736(12)60990-8
39. Bordes J, Cungi PJ, Savoie PH, Bonnet S, Kaiser E. Usefulness of routine preoperative testing in a developing country: a prospective study. Pan Afr Med J. 2015;21. doi:10.11604/pamj.2015.21.94.5860
40. Pal KM, Khan IA, Safdar B. Preoperative work up: are the requirements different in a developing country? JPMA J Pak Med Assoc. 1998;48(11):339-341.
41. Grubert TA, Reindell D, Kästner R, et al. Rates of postoperative complications among human immunodeficiency virus-infected women who have undergone obstetric and gynecologic surgical procedures. Clin Infect Dis Off Publ Infect Dis Soc Am. 2002;34(6):822-830. doi:10.1086/339043
42. Oodit R, Biccard BM, Panieri E, et al. Guidelines for Perioperative Care in Elective Abdominal and Pelvic Surgery at Primary and Secondary Hospitals in Low–Middle-Income Countries (LMIC’s): Enhanced Recovery After Surgery (ERAS) Society Recommendation. World J Surg. 2022;46(8):1826-1843. doi:10.1007/s00268-022-06587-w
43. George T. Semi-Structured Interview | Definition, Guide & Examples. Scribbr. Published May 4, 2022. Accessed January 16, 2023. https://www.scribbr.co.uk/research-methods/semi-structured-interviews/