Before elective surgery, patients often have routine screening such as electrocardiogram (ECG), chest x-ray (CXR) and blood chemistry workup to identify potential complications. The notion that this information makes surgery safer is appealing, yet a growing body of research and expert opinion indicates that for patients having low-risk surgical procedures, routine testing is not beneficial. Studies have shown that it may detect abnormalities, but the significance in patients without symptoms is uncertain, nor is there evidence to support using tests as a baseline for comparison in the event of complications.
Preoperative testing is likely influenced by non-clinical factors. With considerable pressure on hospitals to reduce length of stay, preoperative patient evaluation is often conducted at outpatient clinics where pre-specified algorithms that are insensitive to particular patient and procedure characteristics may direct testing. Medico-legal concerns may also prompt testing despite the fact that results are not always reviewed before surgery, thereby actually increasing legal liability.
Scientists at the Institute for Clinical Evaluative Sciences (ICES) examined patterns of chest radiography and electrocardiography prior to common low- and intermediate-risk elective surgical procedures in Ontario acute-care hospitals.
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