Preoperative Testing in the Era of Cost Containment: Is There a Limit?

This chapter presents the existing data on the value of preoperative testing during an era of cost containment. The first step is to identify the need for these tests by evaluating the type of surgery planned and the patient characteristics and comorbidities. The basic concept involved is the need to find a balance between different factors, such as the patient with their own unique medical problems, the type of surgery with its own challenges, the urgency to proceed to the operating room and, last but not least, the cost involved. The most important message is that preoperative testing should not be a matter of routine, but it should be based on the medical needs of the patient and the complexity of the surgery. While multiple studies have established that preoperative “routine” testing is not necessary, that does not mean there is no need for preoperative evaluation of the patient by the anesthesiologist and the surgeon; on the contrary, it means that the preoperative evaluation is critical in determining what tests are really needed. Throughout this chapter, studies will be presented to clarify the points made in a realistic setting.