Report weighs costs versus value of pre-surgery lab testing

May 21, 2021

About half of patients who had one of three common surgical procedures done in Michigan between 2015 and the midway point of 2019 received at least one routine test beforehand—even though evidence suggests that preoperative testing is often unnecessary for low-risk surgeries, reported Michigan Medicine.

The findings are from new research in JAMA Internal Medicine from a collaboration between the University of Michigan-based Michigan Program on Value Enhancement (MPrOVE) and the Michigan Value Collaborative, a statewide initiative that focuses on improving medical and surgical quality.

“There aren’t that many areas in medicine where the data is pretty definitive that something is low-value,” says Lesly Dossett, MD, Division Chief of Surgical Oncology at Michigan Medicine and the Co-Director of MPrOVE, “but preoperative testing before low-risk surgeries is certainly one of them.”

Professional organizations ranging from the American College of Surgeons and the Society of General Internal Medicine to the American Society of Anesthesiologists have identified routine preoperative testing as a low-value type of care that should be reduced whenever possible.

Of about 40,000 patients in the U-M study who had surgery to either remove the gall bladder, repair a groin hernia or remove cancerous breast tissue, close to a third underwent two or more tests beforehand, and about 13% had three or more. The most common tests were a complete blood count, an electrocardiogram, and a basic metabolic panel — all of which aren’t inherently necessary before these surgeries.

Patients who had a complete medical history and physical done during a visit that was separately billed were more likely to have had preoperative testing as were those who were older or had more than one medical condition.

The data also revealed wide variations in testing, not only between the 63 hospitals studied but also within health systems for the same procedures, pointing to the need for more research to drill down further into the origins of the problem.

This study represents one of the first partnerships between the Michigan Value Collaborative and MPrOVE, a joint venture of IHPI and Michigan Medicine that tries to optimize patient care, improve quality and demonstrate the value of care at Michigan Medicine through research and analytics.

University of Michigan has the report.