Statewide trends in routine pre-operative testing before low-risk surgery - 29/01/26

Doi : 10.1016/j.amjsurg.2025.116815

Nicole M. Mott ^a,^b,^c,^{^{f
These two authors contributed equally to this work.}}, Erin Kim ^d,^{^{f
These two authors contributed equally to this work.}}, Faelan Jacobson-Davies ^a, Michael J. Englesbe ^a,^e, Hari Nathan ^a,^e, Lesly A. Dossett ^a,^e,^⁎

^a University of Michigan, Center for Healthcare Outcomes and Policy, Ann Arbor, MI, USA

^b National Clinician Scholars Program, University of Michigan, Ann Arbor, MI, USA

^c Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI, USA

^d University of Michigan Medical School, Ann Arbor, MI, USA

^e University of Michigan, Department of Surgery, Ann Arbor, MI, USA

^⁎ Corresponding author. Division of Surgical Oncology Maud T Lane Research Professor of Cancer Quality Improvement 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA. Division of Surgical Oncology Maud T Lane Research Professor of Cancer Quality Improvement 1500 E Medical Center Dr Ann Arbor MI 48109 USA

Abstract

Background

Routine pre-operative testing before low-risk surgery remains common despite guidelines against it.

Methods

We conducted a retrospective cohort study of adults undergoing low-risk surgery (cholecystectomy, hernia repair, lumpectomy, thyroidectomy, mastectomy) in Michigan from 2015 to 2024. The primary outcome was testing performed within 30 days of surgery. Linear mixed models identified predictors of testing, and the results of a pilot quality improvement (QI) initiative to reduce testing at 31 hospitals were examined.

Results

Among 99,501 patients, testing rates declined from 44 % to 39 % from 2019 to 2024. Older age, comorbidity burden, and undergoing a pre-operative history and physical were associated with testing. Hospital testing rates varied from 13 % to 93 %. In the QI-participating hospitals, testing declined from 38 % to 33 % in the measurement period compared to the baseline period (p = 0.035).

Conclusions

Pre-operative testing remains common and variable. QI initiatives help reduce testing, but broader de-implementation strategies may promote sustained improvement.

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Highlights

•	Routine pre-operative testing remains common, despite guideline recommendations against it.
•	Testing patterns vary widely across hospitals and patient subgroups.
•	A pilot quality improvement initiative reduced low-value testing.
•	Broader de-implementation efforts may promote sustained practice change.

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Keywords : Choosing Wisely, Quality improvement, Low-value care, Preoperative testing

Plan

quality improvement initiative

Outcome and predictor variables

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Article 116815- mars 2026 Retour au numéro

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Statewide trends in routine pre-operative testing before low-risk surgery - 29/01/26

Abstract

Background

Methods

Results

Conclusions

Highlights

Plan

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