Preoperative Diagnostic Testing and Utilization of Basic Statistics-References

References

Pdf Summary

The referenced literature from 1989 to 2023 comprehensively addresses preoperative diagnostic testing, focusing on the relevance, efficiency, and clinical value of routine tests before surgery. Early works emphasize clinical assessment over excessive reliance on laboratory testing, suggesting that physician evaluation often suffices for preoperative risk stratification (Roizen 1989, 2000; Boland et al. 1996). Multiple studies question the utility of routine tests such as preoperative electrocardiograms, chest x-rays, and hemostatic screening, especially in low-risk or ambulatory patients, demonstrating limited predictive value for postoperative complications (Schein et al. 2000; Liu et al. 2002; Joo et al. 2005; Burk et al. 1992; Liu et al. 2023).<br /><br />Evidence-based guidelines by professional societies (e.g., American College of Cardiology/American Heart Association, American Society of Anesthesiologists) recommend selective testing informed by patient history, clinical examination, and specific risk factors rather than blanket screening (Fleisher et al. 2007; ASA Task Force 2002). Emphasis is placed on assessing cardiovascular risk using validated risk scores (D’Agostino et al. 2008) and perioperative pulmonary and renal risk stratification (Qaseem et al. 2006; Ackland et al. 2011).<br /><br />Several references highlight the cost implications and healthcare resource utilization concerns associated with routine preoperative screening, particularly in Medicare populations undergoing low-risk procedures such as cataract surgery (Chen et al. 2015, 2018; Kirkham et al. 2015). The literature advocates for application of statistical tools such as sensitivity, specificity, predictive values, and Bayesian reasoning to better interpret the diagnostic yield of testing and minimize unnecessary investigations (Simon and Boring 1990; Fagan 1975).<br /><br />Overall, the body of evidence supports a more judicious, individualized approach to preoperative diagnostic testing, aligning with "Choosing Wisely" principles to reduce unnecessary testing, optimize patient care, and conserve healthcare resources.

Keywords

preoperative diagnostic testing

routine preoperative tests

clinical assessment

risk stratification

electrocardiogram

chest x-ray

hemostatic screening

evidence-based guidelines

cardiovascular risk assessment

healthcare resource utilization