Unindicated preoperative testing: ASA physical status and financial implications

STUDY OBJECTIVE: To determine if the ordering of unindicated preoperative laboratory tests is different for healthy (ASA physical status I and II) versus sicker (ASA physical status III) patients, and to examine the financial implications at our institution of unindicated preoperative testing. DESIGN: Prospective, cross-sectional study. SETTING: University hospital. PATIENTS: 383 consecutive patients scheduled for elective surgery and seen by an anesthesiologist in the Preoperative Clinic. Complete data was available for 312 patients. MEASUREMENTS AND MAIN RESULTS: Preoperative laboratory tests ordered by the surgeon were compared to those tests considered indicated by one of several anesthesiologists for ASA physical status I and II versus ASA physical status III patients. An average of 72.5% of tests ordered by surgeons were considered not indicated by the anesthesiologists. ASA physical status III patients had significantly fewer unindicated complete blood count, platelet count, prothrombin time, partial thromboplastin time, chemistry 12 profile, and chest radiography orders than did ASA physical status I and II patients. Our hospital could generate approximately $80,000 in variable and semifixed cost savings by eliminating these unindicated preoperative tests for the 5,100 patients seen in Preoperative Clinic annually (29% of the total surgical patients). CONCLUSIONS: A large percentage of preoperative tests ordered by surgeons at our institution are not indicated. Eliminating unindicated tests would cut hospital revenues in a climate where testing is fee-for-service and would save the hospital money in a managed-care or capitated system.