When Should a Type and Screen not be Ordered Preoperatively?

Volume 4 • Issue 1 • 1000271 J Anesth Clin Res ISSN:2155-6148 JACR an open access journal As cost control becomes an increasingly large determinant of medical practice, preoperative testing may become an avenue for perioperative cost management. Studies suggest that without guidance, surgical teams routinely order excessive or incorrect tests for their patients preoperatively. In a 1997 study, a panel of anesthesiologists reviewed preoperative test orders for 5,100 patients and determined that 72.5% of tests ordered by surgeons were not indicated. This finding held most strongly in patients with ASA status I or IIas the severity of the patient’s physical status increased, congruence between surgeon-implemented and anesthesiologist-recommended tests increased considerably [1]. Similarly, in a comparative study of routine preoperative testing as ordered by the surgical team versus orders by anesthesiologists and anesthesia residents, Finegan et al. found that when staff anesthesiologists ordered preoperative tests, the number of tests performed (and cost accrued) was reduced and the specificity of tests ordered increased without an attributable difference in patient outcomes [2]. Unfortunately, anesthesiologists often do not have the opportunity to dictate preoperative testing to the extent that might generate healthcare savings; however, the surgical literature itself questions the utility of testing all patients irrespective of comorbidities and surgery type [3-7].