{"id":261,"date":"2014-02-03T01:36:50","date_gmt":"2014-02-03T01:36:50","guid":{"rendered":"http:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/?p=261"},"modified":"2017-08-21T13:00:29","modified_gmt":"2017-08-21T13:00:29","slug":"primary-care-corner-with-dr-geoff-modest-preop-testing-many-studies-little-evidence","status":"publish","type":"post","link":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/2014\/02\/03\/primary-care-corner-with-dr-geoff-modest-preop-testing-many-studies-little-evidence\/","title":{"rendered":"Primary Care Corner with Dr. Geoff Modest: Preop testing&#8211;Many studies, little evidence"},"content":{"rendered":"<p>agency for healthcare research and quality (AHRQ) just came out with their synthesis of the data on routine preoperative testing (see link:\u00a0<a href=\"http:\/\/effectivehealthcare.ahrq.gov\/search-for-guides-reviews-and-reports\/?pageaction=displayproduct&amp;productID=1846\">http:\/\/effectivehealthcare.ahrq.gov\/search-for-guides-reviews-and-reports\/?pageaction=displayproduct&amp;productID=1846<\/a>\u00a0). \u00a0assessed literature on kids and adults of routine testing vs no testing or ad hoc testing, and routine vs per-protocol testing (per-protocol testing is testing a subset, eg EKG for those &gt; 50yo, or hct in premenopausal women). \u00a057 studies reviewed (14 comparative and 43 cohort). results:<\/p>\n<p>&nbsp;<\/p>\n<p>good\u00a0<a href=\"news:\">news:<\/a>\u00a0data for cataract surgery is the best: routine pre-op testing (EKG, metabolic panel or glucose, cbc) has no effect on total perioperative complications.<\/p>\n<p>&nbsp;<\/p>\n<p>bad\u00a0<a href=\"news:\">news:<\/a>\u00a0insufficient evidence for all other procedures and insufficient evidence comparing routine and per-protocol testing. no evidence regarding quality of life or satisfaction, resource utilization, or harms of testing. \u00a0and, results of cataract surgery pre-op is not applicable to other patients undergoing other higher risk procedures. even tonsillectomy\/adenoidectomy in kids &#8212; just one retrospective, flawed study, so unable to draw conclusions.<\/p>\n<p>&nbsp;<\/p>\n<p>the issue is that there just are not enough good studies (though 4581 citations assessed). many studies done, but poor quality. good studies need to look at real benefits\/risks, including positive outcomes by testing (fewer medical complications, appropriate changes in perioperative management) vs risks (false positives or irrelevant findings, leading to further testing with attendant complications &#8212; medical and psychological; unnecessary delays in surgery; unnecessary radiation exposure; cost).<\/p>\n<p>&nbsp;<\/p>\n<p>geoff<\/p>\n","protected":false},"excerpt":{"rendered":"<p>agency for healthcare research and quality (AHRQ) just came out with their synthesis of the data on routine preoperative testing (see link:\u00a0http:\/\/effectivehealthcare.ahrq.gov\/search-for-guides-reviews-and-reports\/?pageaction=displayproduct&amp;productID=1846\u00a0). \u00a0assessed literature on kids and adults of routine testing vs no testing or ad hoc testing, and routine vs per-protocol testing (per-protocol testing is testing a subset, eg EKG for those &gt; 50yo, [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/2014\/02\/03\/primary-care-corner-with-dr-geoff-modest-preop-testing-many-studies-little-evidence\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":148,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[14283],"tags":[],"class_list":["post-261","post","type-post","status-publish","format-standard","hentry","category-archive"],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/posts\/261","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/users\/148"}],"replies":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/comments?post=261"}],"version-history":[{"count":0,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/posts\/261\/revisions"}],"wp:attachment":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/media?parent=261"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/categories?post=261"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/tags?post=261"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}