ArticleCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne2015
Preoperative testing before low-risk surgical procedures.
Article in CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05526495 (Does a Theory-Based Intervention to Improve Accountability Reduce Low-Value Preoperative Investigations in Patients Undergoing Low Risk Surgery?), which is not on this map. Cited by 38 papers, 1 of them a synthesis that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Does a Theory-Based Intervention to Improve Accountability Reduce Low-Value Preoperative Investigations in Patients Undergoing Low Risk Surgery?
Who cites it
38 citing papers in PubMed, 1 synthesis or guideline pooled it, 87 citations in OpenAlex.
- Inappropriate use of clinical practices in Canada: a systematic review.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2022Pooled it
- Right-Sizing Testing Before Elective Surgery for Patients With Low Risk.JAMA network open · 2025Article
- Overcoming inertia: Provider perspectives on de-implementation strategies in preoperative testing.American journal of surgery · 2025Article
- Preoperative electrocardiogram in prediction of 90-day postoperative mortality: retrospective cohort study.BMC anesthesiology · 2024Article
- Identifying Strategies to Reduce Low-Value Preoperative Testing for Low-Risk Procedures: a Qualitative Study of Facilities with High or Recently Improved Levels of Testing.Journal of general internal medicine · 2023Article
- Beyond guideline knowledge: a theory-based qualitative study of low-value preoperative testing.Perioperative medicine (London, England) · 2023Article
- Prevalence and Cost of Care Cascades Following Low-Value Preoperative Electrocardiogram and Chest Radiograph Within the Veterans Health Administration.Journal of general internal medicine · 2023Article
- Practical role of preoperative echocardiography in low-risk non-cardiac surgery.Frontiers in cardiovascular medicine · 2023Article
- Frequency and costs of low-value preoperative tests for patients undergoing low-risk procedures in the veterans health administration.Perioperative medicine (London, England) · 2022Article
- Characterizing and quantifying low-value diagnostic imaging internationally: a scoping review.BMC medical imaging · 2022Article
- Prevalence and Factors Associated With Low-Value Preoperative Testing for Patients Undergoing Carpal Tunnel Release at an Academic Medical Center.Hand (New York, N.Y.) · 2022Article
- Evaluation of choosing wisely recommendations on preprocedural cardiovascular testing.American heart journal plus : cardiology research and practice · 2022Article
- Article
- Implementation science for the adductor canal block: A new and adaptable methodology process.World journal of orthopedics · 2021Article
- An Association Between Cardiologist Billing Patterns, Health Care Use, and Outcomes in Cardiac Patients.CJC open · 2021Article
- Hospital characteristics associated with low-value care in public hospitals in New South Wales, Australia.BMC health services research · 2020Article
- Article
- De-implementing wisely: developing the evidence base to reduce low-value care.BMJ quality & safety · 2020Article
- Observational
- Variability and Costs of Low-Value Preoperative Testing for Carpal Tunnel Release Surgery.Anesthesia and analgesia · 2019Article
Corrections and comments
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Authors and funding
9 authors at 1 institution in 2 countries.
Funding
Abstract
backgroundThere is concern about increasing utilization of low-value health care services, including preoperative testing for low-risk surgical procedures. We investigated temporal trends, explanatory factors, and institutional and regional variation in the utilization of testing before low-risk procedures.
methodsFor this retrospective cohort study, we accessed linked population-based administrative databases from Ontario, Canada. A cohort of 1 546 223 patients 18 years or older underwent a total of 2 224 070 low-risk procedures, including endoscopy and ophthalmologic surgery, from Apr. 1, 2008, to Mar. 31, 2013, at 137 institutions in 14 health regions. We used hierarchical logistic regression models to assess patient- and institution-level factors associated with electrocardiography (ECG), transthoracic echocardiography, cardiac stress test or chest radiography within 60 days before the procedure.
resultsEndoscopy, ophthalmologic surgery and other low-risk procedures accounted for 40.1%, 34.2% and 25.7% of procedures, respectively. ECG and chest radiography were conducted before 31.0% (95% confidence interval [CI] 30.9%-31.1%) and 10.8% (95% CI 10.8%-10.8%) of procedures, respectively, whereas the rates of preoperative echocardiography and stress testing were 2.9% (95% CI 2.9%-2.9%) and 2.1% (95% CI 2.1%-2.1%), respectively. Significant variation was present across institutions, with the frequency of preoperative ECG ranging from 3.4% to 88.8%. Receipt of preoperative ECG and radiography were associated with older age (among patients 66-75 years of age, for ECG, adjusted odds ratio [OR] 18.3, 95% CI 17.6-19.0; for radiography, adjusted OR 2.9, 95% CI 2.8-3.0), preoperative anesthesia consultation (for ECG, adjusted OR 8.7, 95% CI 8.5-8.8; for radiography, adjusted OR 2.2, 95% CI 2.1-2.2) and preoperative medical consultation (for ECG, adjusted OR 6.8, 95% CI 6.7-6.9; for radiography, adjusted OR 3.6, 95% CI 3.5-3.6). The median ORs for receipt of preoperative ECG and radiography were 2.3 and 1.6, respectively.
interpretationDespite guideline recommendations to limit testing before low-risk surgical procedures, preoperative ECG and chest radiography were performed frequently. Significant variation across institutions remained after adjustment for patient- and institution-level factors.
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