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The Resource Benefits and harms of routine preoperative testing : comparative effectiveness, prepared for Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services ; prepared by Brown Evidence-based Practice Center ; investigators, Ethan M. Balk, M.D., M.P.H., Amy Earley, B.S., Nira Hadar, M.S., Nirav Shah, M.D., Thomas A. Trikalinos, M.D., Ph.D

Benefits and harms of routine preoperative testing : comparative effectiveness, prepared for Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services ; prepared by Brown Evidence-based Practice Center ; investigators, Ethan M. Balk, M.D., M.P.H., Amy Earley, B.S., Nira Hadar, M.S., Nirav Shah, M.D., Thomas A. Trikalinos, M.D., Ph.D

Creator
Author
Contributor
Summary
Objectives: Preoperative testing is used to guide the action plan for patients undergoing surgical and other procedures that require anesthesia and to predict potential postoperative complications. There is uncertainty whether routine or per-protocol testing in the absence of a specific indication prevents complications and improves outcomes, or whether it causes unnecessary delays, costs, and harms due to false-positive results. Data source: We searched MEDLINE (r) and Ovid Healthstar (r) (from inception to July 22, 2013), as well as Cochrane Central Trials Registry and Cochrane Database of Systematic Reviews. Review methods: We included comparative and cohort studies of both adults and children undergoing surgical and other procedures requiring either anesthesia or sedation (excluding local anesthesia). We included all preoperative tests that were likely to be conducted routinely (in all patients) or on a per-protocol basis (in selected patients). For comparative studies, the comparator of interest was either no testing or ad hoc testing done at the discretion of the clinician. We also looked for studies that compared routine and per-protocol testing. The outcomes of interest were mortality, perioperative events, complications, patient satisfaction, resource utilization, and harms related to testing. Results: Fifty-seven studies (14 comparative and 43 cohort) met inclusion criteria for the review. Well-conducted randomized controlled trials (RCTs) of cataract surgeries suggested that routine testing with electrocardiography, complete blood count, and/or a basic metabolic panel did not affect procedure cancellations (2 RCTs, relative risks [RRs] of 1.00 or 0.97), and there was no clinically important difference for total complications (3 RCTs, RR = 0.99; 95% confidence interval, 0.86 to 1.14). Two RCTs and six nonrandomized comparative studies of general elective surgeries in adults varied greatly in the surgeries and patients included, along with the routine or per-protocol tests used. They also mostly had high risk of bias due to lack of adjustment for patient and clinician factors, making their results unreliable. Therefore, they yielded insufficient evidence regarding the effect of routine or per-protocol testing on complications and other outcomes. There was also insufficient evidence for patients undergoing other procedures. No studies reported on quality of life, patient satisfaction, or harms related to testing. Conclusions: There is high strength of evidence that, for patients scheduled for cataract surgery, routine preoperative testing has no effect on total perioperative complications or procedure cancellation. There is insufficient evidence for all other procedures and insufficient evidence comparing routine and per-protocol testing. There is no evidence regarding quality of life or satisfaction, resource utilization, or harms of testing and no evidence regarding other factors that may affect the balance of benefits and harms. The findings of the cataract surgery studies are not reliably applicable to other patients undergoing other higher risk procedures. Except arguably for cataract surgery, numerous future adequately powered RCTs or well-conducted and analyzed observational comparative studies are needed to evaluate the benefits and harms of routine preoperative testing in specific groups of patients with different risk factors for surgical and anesthetic complications undergoing specific types of procedures and types of anesthesia
Language
eng
Work
Publication
Extent
1 online resource (187 pages)
Note
"January 2014."
Instance
Label
Benefits and harms of routine preoperative testing : comparative effectiveness
Title
Benefits and harms of routine preoperative testing
Title remainder
comparative effectiveness
Statement of responsibility
prepared for Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services ; prepared by Brown Evidence-based Practice Center ; investigators, Ethan M. Balk, M.D., M.P.H., Amy Earley, B.S., Nira Hadar, M.S., Nirav Shah, M.D., Thomas A. Trikalinos, M.D., Ph.D
Title variation
Effective health care program
Creator
Contributor
Author
Issuing body
Subject
Genre
Language
eng
Summary
Objectives: Preoperative testing is used to guide the action plan for patients undergoing surgical and other procedures that require anesthesia and to predict potential postoperative complications. There is uncertainty whether routine or per-protocol testing in the absence of a specific indication prevents complications and improves outcomes, or whether it causes unnecessary delays, costs, and harms due to false-positive results. Data source: We searched MEDLINE (r) and Ovid Healthstar (r) (from inception to July 22, 2013), as well as Cochrane Central Trials Registry and Cochrane Database of Systematic Reviews. Review methods: We included comparative and cohort studies of both adults and children undergoing surgical and other procedures requiring either anesthesia or sedation (excluding local anesthesia). We included all preoperative tests that were likely to be conducted routinely (in all patients) or on a per-protocol basis (in selected patients). For comparative studies, the comparator of interest was either no testing or ad hoc testing done at the discretion of the clinician. We also looked for studies that compared routine and per-protocol testing. The outcomes of interest were mortality, perioperative events, complications, patient satisfaction, resource utilization, and harms related to testing. Results: Fifty-seven studies (14 comparative and 43 cohort) met inclusion criteria for the review. Well-conducted randomized controlled trials (RCTs) of cataract surgeries suggested that routine testing with electrocardiography, complete blood count, and/or a basic metabolic panel did not affect procedure cancellations (2 RCTs, relative risks [RRs] of 1.00 or 0.97), and there was no clinically important difference for total complications (3 RCTs, RR = 0.99; 95% confidence interval, 0.86 to 1.14). Two RCTs and six nonrandomized comparative studies of general elective surgeries in adults varied greatly in the surgeries and patients included, along with the routine or per-protocol tests used. They also mostly had high risk of bias due to lack of adjustment for patient and clinician factors, making their results unreliable. Therefore, they yielded insufficient evidence regarding the effect of routine or per-protocol testing on complications and other outcomes. There was also insufficient evidence for patients undergoing other procedures. No studies reported on quality of life, patient satisfaction, or harms related to testing. Conclusions: There is high strength of evidence that, for patients scheduled for cataract surgery, routine preoperative testing has no effect on total perioperative complications or procedure cancellation. There is insufficient evidence for all other procedures and insufficient evidence comparing routine and per-protocol testing. There is no evidence regarding quality of life or satisfaction, resource utilization, or harms of testing and no evidence regarding other factors that may affect the balance of benefits and harms. The findings of the cataract surgery studies are not reliably applicable to other patients undergoing other higher risk procedures. Except arguably for cataract surgery, numerous future adequately powered RCTs or well-conducted and analyzed observational comparative studies are needed to evaluate the benefits and harms of routine preoperative testing in specific groups of patients with different risk factors for surgical and anesthetic complications undergoing specific types of procedures and types of anesthesia
Member of
Cataloging source
MMU
http://library.link/vocab/creatorName
Balk, Ethan
Funding information
This report is based on research conducted by the Brown Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ)
Government publication
federal national government publication
Illustrations
illustrations
Index
no index present
Literary form
non fiction
Nature of contents
  • dictionaries
  • bibliography
NLM call number
WO 234
http://library.link/vocab/relatedWorkOrContributorName
  • Earley, Amy
  • Hadar, Nira
  • Shah, Nirav
  • Trikalinos, Thomas A.
  • United States
  • Brown University Center for Evidence-Based Medicine
  • Effective Health Care Program (U.S.)
Series statement
  • Comparative effectiveness review
  • AHRQ publication
Series volume
  • number 130
  • no. 14-EHC009-EF
http://library.link/vocab/subjectName
Preoperative Care
http://bibfra.me/vocab/relation/supportingbody
  • SGEpYsXqBGk
  • RzTDSdffmEM
Label
Benefits and harms of routine preoperative testing : comparative effectiveness, prepared for Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services ; prepared by Brown Evidence-based Practice Center ; investigators, Ethan M. Balk, M.D., M.P.H., Amy Earley, B.S., Nira Hadar, M.S., Nirav Shah, M.D., Thomas A. Trikalinos, M.D., Ph.D
Instantiates
Publication
Note
"January 2014."
Bibliography note
Includes bibliographical references
Carrier category
online resource
Carrier category code
cr
Carrier MARC source
rdacarrier.
Content category
text
Content type code
txt
Content type MARC source
rdacontent.
Control code
872268212
Extent
1 online resource (187 pages)
Form of item
online
Media category
computer
Media MARC source
rdamedia.
Media type code
c
Other physical details
illustrations.
Specific material designation
remote
System control number
(OCoLC)872268212
Label
Benefits and harms of routine preoperative testing : comparative effectiveness, prepared for Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services ; prepared by Brown Evidence-based Practice Center ; investigators, Ethan M. Balk, M.D., M.P.H., Amy Earley, B.S., Nira Hadar, M.S., Nirav Shah, M.D., Thomas A. Trikalinos, M.D., Ph.D
Publication
Note
"January 2014."
Bibliography note
Includes bibliographical references
Carrier category
online resource
Carrier category code
cr
Carrier MARC source
rdacarrier.
Content category
text
Content type code
txt
Content type MARC source
rdacontent.
Control code
872268212
Extent
1 online resource (187 pages)
Form of item
online
Media category
computer
Media MARC source
rdamedia.
Media type code
c
Other physical details
illustrations.
Specific material designation
remote
System control number
(OCoLC)872268212

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