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Publication Briefs

Study Suggests Routine Preoperative Screening Tests for Very Low-Risk Procedures are Common and Costly for VA

For patients undergoing low-risk procedures, preoperative screening tests often do not change clinical management and sometimes lead to unnecessary follow-up testing and interventions that may delay surgery. Even though guidance to avoid preoperative testing has been available for years, low-value preoperative tests continue to be a major contributor to unnecessary healthcare spending in the US. While previous studies have shown that there has been some low-value preoperative screening in the VA healthcare system (i.e., prior to cataract surgery), it is unknown if these patterns of low-value testing generalize to a variety of other minor procedures. Therefore, this study sought to determine the frequency and costs of potentially low-value preoperative screening tests among VA patients undergoing low-risk procedures. Using VA data, investigators identified 148,728 Veterans who underwent low-risk procedures (i.e., carpal tunnel release, cyst excision) without general anesthesia during FY2019 – and then assessed the overall national and facility-level rates and costs of nine common tests received in the 30 days prior to the procedure. Tests that were examined included: complete blood count, basic metabolic panel, coagulation tests, urinalysis, electro-cardiography, pulmonary function tests, trans-thoracic echocardiograms, cardiac stress tests, and chest x-rays. Patient demographics and comorbidities, as well as facility characteristics, also were assessed.


  • Routine preoperative screening tests for very low risk procedures were common and costly in some VA facilities: 86,327 of 178,775 low risk procedures (49%) were preceded by 321,917 potentially low-value screening tests. This may represent more than $11 million in low-value care.
  • Complete blood count was the most common test (33% of procedures), followed by basic metabolic profile (32%), urinalysis (26%), electrocardiography (19%), and pulmonary function test (12%).
  • Older age, female sex, Black race, and having more comorbidities were associated with higher odds of low-value testing.
  • The top quartile of VA facilities with the highest testing cost accounted for 57% of total costs.


  • One way to address low-value preoperative testing is to develop quality measures of low-value care that could be integrated into VA’s extensive quality monitoring infrastructure. Further, by identifying facilities with the highest burden of low-value care, then seeking to identify its root causes, interventions can be designed and implemented to improve the quality of care by providing less of it.


  • There is no way to be sure that tests ordered in the 30 days prior to a low-risk procedure were ordered for preoperative screening purposes. In addition, some tests that are generally low value may be justified by individual factors.

This study was funded by HSR&D (IIR 16-216), and Dr. Harris is supported by an HSR&D Research Career Scientist award. Drs. Harris, Bowe, Hawn, Eisenberg, Finlay, and Mudumbai are part of HSR&D’s Center for Innovation to Implementation (Ci2i): Fostering High-Value Care in Palo Alto, CA.

Harris A, Bowe T, Kamal R, et al. Frequency and Costs of Low-Value Preoperative Tests for Patients Undergoing Low-Risk Procedures in the Veterans Health Administration. Perioperative Medicine. September 13, 2022;11(1):33.

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HSR requires notification by HSR-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR published articles. Visit the HSR citations database for a complete listing of HSR articles and presentations.

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