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

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 under-going 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.