Preoperative test requests for elective surgeries of different complexity: Appropriateness and interhospital variability

IF 5.1 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia Pub Date : 2026-01-01 Epub Date: 2025-10-16 DOI:10.1016/j.jclinane.2025.112033

Antonio Sánchez-Hidalgo , Iratxe Urreta Barallobre , Ignasi Bolibar Ribas , Eva Bassas Parga , Miren Arrieta Bernaras , Gaizka Gutiérrez Sánchez , David Sánchez Cirera , Francisco José González Moraga , Inigo Gorostiza , Raúl de Frutos Parra , Susana Álvarez Gómez , Pablo Manuel Keenoy , Marta Roqué Figuls , Carolina Requeijo

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引用次数: 0

Abstract

Background

Numerous studies have questioned the usefulness of routine preoperative tests, and several guidelines have published recommendations aimed at reducing unnecessary preoperative testing.

Study objectives

To analyze the appropriateness of preoperative test requests and interhospital variability in criteria for requesting preoperative tests.

Design

Cross-sectional retrospective multicenter observational study.

Setting

Nine Spanish National Health System hospitals.

Patients

Patients over 18 years of age undergoing elective cataract surgery, inguinal hernia, laparoscopic cholecystectomy, colon surgery or primary knee replacement, in any department of the participating hospitals during 5 working days in June 2022 (n = 1522).

Exposure

Hospitals where patients underwent surgery.

Measurements

Appropriateness of requested preoperative tests according to hospital protocols and NICE guidelines analyzed with random-intercept multilevel models considering hospital-level and patient-level variables. Hospital protocol score to determine disagreement with the NICE guidelines.

Main results

Preoperative test request inappropriateness was 12.03 % according to hospital protocols and 72.99 % according to the NICE guidelines. Inappropriateness was mostly due to excessive requests and differed by hospital and surgery type. Independent factors determining inappropriateness at the hospital-level were center complexity and availability of computerized preoperative request templates; at the patient-level were age, ASA grades and surgical complexity. Protocol criteria for requesting preoperative tests varied notably between hospitals, and most protocols showed low agreement with NICE recommendations, especially in terms of over-requested preoperative tests.

Conclusions

Inappropriateness of preoperative test requests was high according to hospital protocols and especially high according to the NICE guidelines. Appropriateness was determined by patient characteristics, surgical complexity, and institutional factors. Interhospital variability in inappropriateness was explained by differing criteria for preoperative test requests.

查看原文本刊更多论文

不同复杂性择期手术的术前检查要求：适当性和医院间的可变性。

背景：大量研究质疑常规术前检查的有效性，一些指南已发表建议，旨在减少不必要的术前检查。研究目的：分析术前检查要求的适宜性和医院间术前检查要求标准的差异。设计：横断面回顾性多中心观察研究。环境：九家西班牙国家卫生系统医院。患者：于2022年6月5个工作日在参与医院任一科室接受选择性白内障手术、腹股沟疝手术、腹腔镜胆囊切除术、结肠手术或原发性膝关节置换术的18岁以上患者（n = 1522）。暴露：病人接受手术的医院。测量：根据医院方案和NICE指南，采用随机截距多水平模型分析了考虑医院水平和患者水平变量的术前检查的适当性。医院方案评分以确定与NICE指南的不一致。主要结果：根据医院规程，术前检查要求不恰当率为12.03%，根据NICE指南，不恰当率为72.99%。不当性主要是由于过度要求，因医院和手术类型而异。决定医院层面不适宜的独立因素是中心复杂性和计算机化术前请求模板的可用性；在患者水平是年龄、ASA分级和手术复杂程度。要求术前检查的方案标准因医院而异，大多数方案与NICE建议的一致性较低，特别是在要求过多的术前检查方面。结论：根据医院协议，术前检查要求的不适当性很高，特别是根据NICE指南。适当性由患者特征、手术复杂性和机构因素决定。医院间不适宜性的差异可以通过术前检查要求的不同标准来解释。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Clinical Anesthesia 医学-麻醉学

CiteScore

7.40

自引率

4.50%

发文量

346

审稿时长

23 days

期刊介绍： The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained. The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.