Kevin R Riggs1, Eric B Bass2,3, Jodi B Segal2,3. 1. Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama. 2. Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland. 3. Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.
Abstract
OBJECTIVE: To determine the independent association of patient- and surgery-specific risk with receipt of outpatient preoperative testing. METHODS: Using administrative data from 2010-2013 (Marketscan® Commercial Claims and Encounters), we constructed a retrospective cohort of 678,368 privately-insured, non-elderly US adults who underwent one of ten operations, including one lower-risk and one higher-risk operation from five surgical specialties. Outcomes were receipt of nine outpatient tests in the 30 days before surgery and cost of those tests. Patient-specific risk was based on Revised Cardiac Risk Index (RCRI) and, alternatively, the Charlson Comorbidity Index (CCI). Surgery-specific risk was based on operation (higher- versus lower-risk within each specialty). Multivariable logistic regression models were constructed to measure the independent association of patient- and surgery-specific risk with the receipt of tests. RESULTS: Receipt of tests ranged from 0.9% (pulmonary function tests) to 46.8% (blood counts), and 65.2% of patients received at least one test. Mean cost per patient for all tests was $124.38. Higher RCRI was strongly associated (Odds Ratio (OR) >2) with receipt of stress tests and echocardiograms, and more modestly associated [OR <2] with receipt of most other tests. Undergoing higher-risk operations was strongly associated with receipt of most tests. Results were similar using the CCI for patient-specific risk. CONCLUSION: Surgery-specific risk is strongly associated with receipt of most preoperative tests, which is consistent with preoperative testing protocols based as much or more on the planned operation as on patient-specific risk factors. Whether this pattern of preoperative testing represents optimal care is uncertain.
OBJECTIVE: To determine the independent association of patient- and surgery-specific risk with receipt of outpatient preoperative testing. METHODS: Using administrative data from 2010-2013 (Marketscan® Commercial Claims and Encounters), we constructed a retrospective cohort of 678,368 privately-insured, non-elderly US adults who underwent one of ten operations, including one lower-risk and one higher-risk operation from five surgical specialties. Outcomes were receipt of nine outpatient tests in the 30 days before surgery and cost of those tests. Patient-specific risk was based on Revised Cardiac Risk Index (RCRI) and, alternatively, the Charlson Comorbidity Index (CCI). Surgery-specific risk was based on operation (higher- versus lower-risk within each specialty). Multivariable logistic regression models were constructed to measure the independent association of patient- and surgery-specific risk with the receipt of tests. RESULTS: Receipt of tests ranged from 0.9% (pulmonary function tests) to 46.8% (blood counts), and 65.2% of patients received at least one test. Mean cost per patient for all tests was $124.38. Higher RCRI was strongly associated (Odds Ratio (OR) >2) with receipt of stress tests and echocardiograms, and more modestly associated [OR <2] with receipt of most other tests. Undergoing higher-risk operations was strongly associated with receipt of most tests. Results were similar using the CCI for patient-specific risk. CONCLUSION: Surgery-specific risk is strongly associated with receipt of most preoperative tests, which is consistent with preoperative testing protocols based as much or more on the planned operation as on patient-specific risk factors. Whether this pattern of preoperative testing represents optimal care is uncertain.
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