Preoperative test requests for elective surgeries of different complexity: Appropriateness and interhospital variability - 10/12/25

Doi : 10.1016/j.jclinane.2025.112033

Antonio Sánchez-Hidalgo ^a,^b , Iratxe Urreta Barallobre ^c , Ignasi Bolibar Ribas ^d,^e,^{^⁎} , Eva Bassas Parga ^f , Miren Arrieta Bernaras ^g , Gaizka Gutiérrez Sánchez ^h , David Sánchez Cirera ^h , Francisco José González Moraga ⁱ , Inigo Gorostiza ^j , Raúl de Frutos Parra ^k , Susana Álvarez Gómez ^l, Pablo Manuel Keenoy ^m , Marta Roqué Figuls ⁿ , Carolina Requeijo ^o

the MAPAC-MPC (Improvement of the Appropriateness of Healthcare and Clinical Practice) Network
Paloma Salas ¹, Bernardo Marín Gil ¹, Alexandra Sáenz Serna ¹, Clara Manzano Martin ¹, Andreu Edo ¹, Francisco José González Moraga ², Nuria Martínez Merino ², Francisco Javier Sanz Fernández ², Alberto Isla Baranda ³, M. Jesus Quintana ⁴, Xavier Bonfill ⁴, Maria Teresa Puig ⁴, Elisabeth Carreras ⁴, Ascension Garcia ⁴, Laura Samsó ⁴, Gerard Urrútia ⁴, Ivan Sola ⁴, Pilar Paniagua ⁴, Elisenda Pujol Rosa ⁵, Antia Osorio López ⁶, Carme Queralt Pascual ⁶, Marta Maria Amelburu Egoscozabal ⁶, Aitor Izeta Anza ⁶, María Toral Cegarra ⁶, Nuria González Jorrín ⁶, Iñaki Roa Martinez ⁷, Juan Santaella Garcia ⁷, Oihane Sudupe Sanchez ⁷, Zuriñe Churruca Ugarte ⁷, José Giménez Crouseilles ⁸, Carmen Luisa Rodríguez Pérez ⁸

¹ Consorci Sanitari de Terrassa- Hospital Universitari de Terrassa, Spain

² Hospital Gregorio Marañon, Spain

³ Hospital San Eloy, Spain

⁴ Hospital de Sant Pau, Spain

⁵ Hospital Moisès Broggi, Spain

⁶ Hospital Universitario de Donostia, Spain

⁷ Hospital de Zumárraga, Spain

⁸ Parc Sanitari Sant Joan de Déu, Spain

^a Department of Cardiology, Consorci Sanitari de Terrassa-Hospital Universitari de Terrassa, Carretera de Torrebonica s/n, 08227 Terrassa, Spain

^b Department of Medicine, School of Medicine and Heatlh Sciences, Universitat Internacional de Catalunya (UIC), Campus Sant Cugat, Josep Trueta s/n, 08195 Sant Cugat del Vallès, Spain

^c Clinical Epidemiology and Research Unit, Hospital Universitario de Donostia, Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Begiristain Doktorea Pasealekua, s/n, 20014 Donostia, Spain

^d Department of Pediatrics, Obstetrics and Gynecology and Preventive Medicine and Public Health, Autonomous University of Barcelona, Edifici M, Avinguda de Can Domenech, 08193 Bellaterra, Spain

^e Department of Clinical Epidemiology and Public Health, Institut de Recerca Sant Pau (IR SANT PAU), Hospital de la Santa Creu i Sant Pau, Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Pavelló 18 (planta baixa). C/Sant Antoni M. Claret, 167, 08025 Barcelona, Spain

^f Department of Anesthesiology and Critical Care, Complex Hospitalari Moisès Broggi-Consorci Sanitari Integral, Carrer Oriol Martorell, 12, 08970 Sant Joan Despí, Spain

^g Emergency Department, Hospital Zumárraga OSI Goierri Alto Urola, Barrio Argixao s/n, 20700 Zumarraga, Spain

^h Anesthesiology and Reanimation Department, Hospital de la Santa Creu i Sant Pau, Sant Antoni Maria Claret, 167, 08025 Barcelona, Spain

ⁱ Anesthesia and Postoperative Critical Care section of Cardiac Surgery, Hospital Gregorio Marañón, Calle del Dr Esquerdo, 46, 28007 Madrid, Spain

^j Osakidetza, Basurto University Hospital, Research Unit, Avenida de Montevideo, 18, 48013 Bilbao, Spain

^k Department of Anesthesiology and Resuscitation, Basurto University Hospital, Avenida de Montevideo, 18, 48013 Bilbao, Spain

^l Quality and Safety Unit, Parc Sanitari Sant Joan de Déu, Camí Vell de la Colònia, 25, 08830 Sant Boi de Llobregat, Spain

^m Anesthesia Department, Hospital San Eloy, Av. A. Miranda, 5, 48902 Barakaldo, Spain

ⁿ Iberoamerican Cochrane Center, Institut de Recerca Sant Pau (IR SANT PAU), Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Hospital de la Santa Creu i Sant Pau, Pavelló 18 (planta baixa). C/Sant Antoni M. Claret, 167, 08025 Barcelona, Spain

^o Department of Clinical Epidemiology and Public Health, Institut de Recerca Sant Pau (IR SANT PAU), Hospital de la Santa Creu i Sant Pau, Pavelló 18 (planta baixa). C/Sant Antoni M. Claret, 167, 08025 Barcelona, Spain

^⁎ Corresponding author at: Department of Pediatrics, Obstetrics and Gynecology and Preventive Medicine and Public Health, Autonomous University of Barcelona, Edifici M, Avinguda de Can Domenech, 08193 Bellaterra, Spain. Department of Pediatrics, Obstetrics and Gynecology and Preventive Medicine and Public Health Autonomous University of Barcelona Edifici M, Avinguda de Can Domenech Bellaterra 08193 Spain

Abstract

Background

Numerous studies have questioned the usefulness of routine preoperative tests, and several guidelines have published recommendations aimed at reducing unnecessary preoperative testing.

Study objectives

To analyze the appropriateness of preoperative test requests and interhospital variability in criteria for requesting preoperative tests.

Design

Cross-sectional retrospective multicenter observational study.

Setting

Nine Spanish National Health System hospitals.

Patients

Patients over 18 years of age undergoing elective cataract surgery, inguinal hernia, laparoscopic cholecystectomy, colon surgery or primary knee replacement, in any department of the participating hospitals during 5 working days in June 2022 ( n = 1522).

Exposure

Hospitals where patients underwent surgery.

Measurements

Appropriateness of requested preoperative tests according to hospital protocols and NICE guidelines analyzed with random-intercept multilevel models considering hospital-level and patient-level variables. Hospital protocol score to determine disagreement with the NICE guidelines.

Main results

Preoperative test request inappropriateness was 12.03 % according to hospital protocols and 72.99 % according to the NICE guidelines. Inappropriateness was mostly due to excessive requests and differed by hospital and surgery type. Independent factors determining inappropriateness at the hospital-level were center complexity and availability of computerized preoperative request templates; at the patient-level were age, ASA grades and surgical complexity. Protocol criteria for requesting preoperative tests varied notably between hospitals, and most protocols showed low agreement with NICE recommendations, especially in terms of over-requested preoperative tests.

Conclusions

Inappropriateness of preoperative test requests was high according to hospital protocols and especially high according to the NICE guidelines. Appropriateness was determined by patient characteristics, surgical complexity, and institutional factors. Interhospital variability in inappropriateness was explained by differing criteria for preoperative test requests.

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Highlights

•	Preoperative test request inappropriateness according to hospital protocols is high.
•	Inappropriateness is especially high according to more restrictive NICE guidelines.
•	Inappropriateness was determined by patient characteristics, surgical risk, and hospital-level factors.
•	Inappropriateness has a moderate heterogeneity across centers.
•	Interhospital variability may be due to differing preoperative test request criteria.

Le texte complet de cet article est disponible en PDF.

Keywords : Appropriateness, Preoperative tests, Interhospital variability

Plan

Introduction

Methods

Study design and participants

Procedures

Statistical analysis

Results

Appropriateness of preoperative test requests

Interhospital protocol variability

Discussion

Appropriateness of preoperative test requests

Interhospital protocol variability

Study limitations

Conclusions

CRediT authorship contribution statement

Declaration of generative AI and AI-assisted technologies in the writing process

Funding

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Article 112033- janvier 2026 Retour au numéro

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Preoperative test requests for elective surgeries of different complexity: Appropriateness and interhospital variability - 10/12/25

Abstract

Background

Study objectives

Design

Setting

Patients

Exposure

Measurements

Main results

Conclusions

Highlights

Plan

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