For many patients, preparing for surgery involves a series of routine tests, including blood work, electrocardiograms (ECGs), and metabolic panels. However, emerging research highlights that not all of these tests are essential—especially when they do not influence surgical outcomes.[1]
A groundbreaking study published in JAMA Surgery by researchers from the University of Michigan (U-M) and Brigham and Women’s Hospital demonstrates that hospitals can safely reduce redundant testing without compromising patient safety. By implementing targeted interventions, the study achieved a significant decline in unnecessary testing, leading to cost savings, reduced patient burden, and improved efficiency for clinical staff.[2]
The study focused on four common preoperative tests in low-risk patients undergoing outpatient procedures such as breast lump removal, gallbladder surgery, or hernia repair. The findings were striking:
Before the intervention, 37% of patients received at least one unnecessary test. By the end of the study, this rate dropped to 14%.
The overall rate of testing among all patients decreased from 51% to 27%.
There was no increase in postoperative complications, emergency visits, or hospitalizations, confirming that reducing unnecessary tests did not compromise patient safety.
Making change together, and measuring its effect
The study’s leader says it’s not just the drop in unnecessary testing, but the way the team achieved it and measured it that makes the study different.
The intervention focused on educating clinicians on the evidence that they could safely reduce testing in some patients, and involving them in how they did so, says senior author and U-M Health surgeon Lesly Dossett, M.D., M.P.H.
“We’re excited by what we were able to achieve at our preop clinics, and look forward to testing this in hospitals statewide," said Dossett.
Dossett co-leads the Michigan Program on Value Enhancement, or MPrOVE, through which the new study was conducted. MPrOVE teams the clinical quality improvement efforts of U-M Health with the rigorous research methods of the U-M Institute for Healthcare Policy and Innovation. It’s funded by Michigan Medicine, U-M’s academic medical center.
If we truly want to reduce wasteful testing, the kind that provides no value and won’t change care, we need to help team members understand the rationale, to base our intervention on what we know about creating lasting positive change, and to provide easy-to-use tools to support clinical decisions
Lesly Dossett, M.D., M.P.H, senior author and U-M Health surgeon
Reducing Unnecessary Preoperative Tests: A Step Towards Efficient Surgical Care
The study, conducted at U-M Health’s preoperative clinics from June 2022 to August 2023, involved 1,143 patients with an average age of 58. It aimed to reduce unnecessary preoperative testing, a previously identified issue in Michigan hospitals.
To address this, surgeons and physician assistants collaborated with the study team, reaching a consensus on necessary tests using decision-support tools like flowcharts and grids. Blood tests called complete blood cell counts (CBCs), basic metabolic panels (BMPs) and comprehensive metabolic panels (CMPs) were targeted, as were electrocardiograms which have been deemed unnecessary for certain patients based on extensive research and healthcare quality guidelines.
Patients were assessed using the ASA Physical Status scale, with those at lower risk exempted from all four tests unless specifically required by a specialist. Even higher-risk patients avoided select tests based on their conditions.
Led by first author Alexis Antunez, M.D., M.S., the study engaged multiple U-M Medical School researchers and was supported by the MPrOVE program. Its success has led to a statewide expansion involving 16 Michigan hospitals, funded by the Agency for Healthcare Research and Quality and Blue Cross Blue Shield of Michigan. This broader study will evaluate the model’s effectiveness in different healthcare settings and its financial impact.
The research team included experts from IHPI, the Center for Healthcare Outcomes and Policy, and the Michigan Value Collaborative, with funding from NIH, AHRQ, and BCBSM’s Value Partnerships program.
In addition to Dossett, Antunez and Cuttita, the study's authors are Ruby J. Kazemi, BA; Caroline Richburg, MD; Cecilia Pesavento, MD, MBA; Andrew Vastardis, MS; Erin Kim, BS; Abigail L. Kappelman, MA; Devak Nanua, MS; Hiba Pediyakkal, BA; Faelan Jacobson-Davies, MA; Shawna N. Smith, PhD; James Henderson, PhD,10; Valerie Gavrila, MPH; and Hari Nathan, MD, PhD.
The study was funded by the National Institutes of Health (T32CA009672), the Agency for Healthcare Research and Quality (R01HS029306-01A1) and Blue Cross Blue Shield of Michigan's support for the Michigan Value Collaborative as part of the BCBSM Value Partnerships program. shorten and collab it rephrase and paraphrase it.
References:
Dossett, Lesly A., Anthony L. Edelman, Gloria Wilkinson, and Shannon M. Ruzycki. "Reducing Unnecessary Preoperative Testing." BMJ 379 (October 6, 2022): e070118. https://www.bmj.com/content/379/bmj-2022-070118.
Antunez, Amanda G., R. Jason Kazemi, Christopher Richburg, Christina Pesavento, Alexander Vastardis, Emily Kim, et al. "Multicomponent Deimplementation Strategy to Reduce Low-Value Preoperative Testing." JAMA Surgery (January 15, 2025). https://jamanetwork.com/journals/jamasurgery/fullarticle/2829134.
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