The Value of Preoperative Screening Investigations in Otherwise Healthy Individuals

TLDR

To evaluate whether routine preoperative screening adds value in otherwise healthy patients, the authors reviewed 2570 cholecystectomy charts and selected 1010 patients without active disease. They assessed the frequency, abnormality rates, predictive value, and clinical impact of routine preoperative tests compared with history and physical examination. Of 5003 tests performed, 225 were abnormal, 104 were potentially important, but only 17 prompted action and 4 yielded conceivable benefit, showing that routine screening provided little additional information beyond history and physical.

Abstract

To assess the value of routine screening preoperative investigations in an otherwise healthy surgical population, the charts of 2570 patients undergoing cholecystectomy in two university teaching hospitals were reviewed. Of these, 1010 patients who were believed to be free of active disease other than cholelithiasis were selected for further study. Preoperative screening investigations were assessed in terms of frequency of use and abnormalities detected. The predictive values of these tests were analyzed and compared with information obtained from the history and physical examination. The frequency with which action was taken because of abnormal test results was also determined. Of the 5003 preoperative screening tests performed, abnormal results were obtained in 225. Of these, 104 were of potential importance. Action resulting from these abnormalities occurred in 17 cases. In only four patients could a conceivable benefit have arisen from a preoperative screening test. When compared with the results of the history and physical examination, routine preoperative investigations provided little further information that altered management in otherwise healthy surgical patients undergoing cholecystectomy.