The deimplementation of laboratory testing in low‐risk patients as recommended by the American society of anesthesiologists: An ACS‐NSQIP longitudinal analysis.

Background: In 2012, the American Society of Anesthesiologists (ASA) published guidelines recommending against routine preoperative laboratory testing for low‐risk patients to reduce unnecessary medical expenditures. The aim of this study was to assess the change in routine preoperative laboratory testing in low‐risk versus higher‐risk patients before and after release of these guidelines. Methods: The ACS‐NSQIP database, 2005–2018, was separated into low‐risk versus higher‐risk patients based upon a previously published stratification. The guideline implementation date was defined as January 2013. Changes in preoperative laboratory testing over time were compared between low‐ and higher‐risk patients. A difference‐in‐differences model was applied. The primary outcome included any laboratory test obtained ≤90 days prior to surgery. Results: Of 7,507,991 patients, 972,431 (13.0%) were defined as low‐risk and 6,535,560 (87.0%) higher‐risk. Use of any preoperative laboratory test declined in low‐risk patients from 66.5% before to 59.6% after guidelines, a 6.9 percentage point reduction, versus 93.0%–91.9% in higher‐risk patients, a 1.1 percentage point reduction (p < 0.0001, comparing percentage point reductions). After risk‐adjustment, the adjusted odds ratio for having any preoperative laboratory test after versus before the guidelines was 0.77 (95% CI 0.76–0.78) in low‐risk versus 0.93 (0.92–0.94) in higher‐risk patients. In low‐risk patients, lack of any preoperative testing was not associated with worse outcomes. Conclusions: While a majority of low‐risk patients continue to receive preoperative laboratory testing not recommended by the ASA, there has been a decline after implementation of guidelines. Continued effort should be directed at the deimplementation of routine preoperative laboratory testing for low‐risk patients. [ABSTRACT FROM AUTHOR]

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