January 28, 2025
Antunez AG, Kazemi RJ, Richburg C, et al. Multicomponent Deimplementation Strategy to Reduce Low-Value Preoperative Testing. JAMA Surg. 2025; in press.
Smith ME, Haynes AB. Effective Deimplementation of Low-Value Preoperative Testing: Choosing Wisely, From Policy to Practice. JAMA Surg. 2025; in press.
Available evidence supports the conclusion that routine preoperative blood tests and electrocardiograms do not reduce adverse events in patients undergoing low-risk surgical procedures such as inguinal hernia, breast lumpectomy, and laparoscopic cholecystectomy. Despite these data, surgeons continue to obtain preoperative blood tests and electrocardiograms prior to low-risk procedures.
This study described a before and after multicomponent quality improvement initiative designed to educate surgeons and reduce preoperative testing. The deimplementation strategy was carried out in a single institution; the study cohort consisted of 1,143 patients who underwent one of the three procedures listed previously.
The baseline rate of preoperative testing was 66%. After the educational intervention the rate of preoperative testing decreased by 17% to 38%, depending on the procedure examined.
The authors concluded that the data suggested that the intervention was effective. In the editorial that accompanied the article, Smith and Haynes agreed that this approach showed potential value, but close monitoring will be necessary to ensure that the reductions in testing are sustained over time.