Preoperative testing in noncardiac surgery patients: a survey amongst European anaesthesiologists

Context Previous surveys of the current practice of preoperative assessment within different countries have shown that there is much variation between different hospitals. Objective The aim of the present study was to document the current clinical practice of preoperative testing for noncardiac surgery in Europe. We also wanted to assess the opinion of anaesthesiologists on eliminating routine preoperative testing. Design Cross-sectional study. Setting Anaesthesiologists from 17 different countries in Europe were surveyed between May and July 2009. Participants Anaesthesiologists registered with a national anaesthesiology society represented in the European Society of Anaesthesiology. Main outcome measures Indications for preoperative tests in different countries within Europe. Results We received 354 completed questionnaires from 17 countries, all from different hospitals. In most countries, the anaesthesiologist has the final responsibility of performing preoperative evaluation (83%) and a preoperative assessment clinic is commonplace (95%). There is a remarkable variation in the way tests are ordered in different practices and also between different countries. About half of the anaesthesiologists indicated that they order preoperative tests in accordance with guidelines. Most respondents (86%) indicated that they would support moves towards a reduction in preoperative testing, but 44% cited patient safety as the main concern if routine testing was eliminated. Conclusion Our survey shows a large variety in organisation and practice of preoperative evaluation throughout Europe. This practice is frequently not in accordance with guideline recommendations. Our survey confirms that there is a shift towards selective testing and also that the majority of respondents support a move towards reducing preoperative testing.