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In Response

Katz, Robert I. MD; Rosenfeld, Kenneth MD; Glass, Peter S. A. MB; Dexter, Franklin MD, PhD

doi: 10.1213/ANE.0b013e31822201fa
Letters to the Editor: Letters & Announcements
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SDC

Department of Anesthesiology University of Florida Gainesville, FL (Katz)

Department of Anesthesiology SUNY at Stony Brook Stony Brook, New York (Rosenfeld, Glass)

Department of Anesthesia University of Iowa Iowa City, Iowa Franklin-Dexter@UIowa.edu (Dexter)

We agree with Drs. Tsai and Polk1 that efficiency and cost containment will include the adoption of accepted standards. This is, indeed, one of the points of our paper. Several studies have demonstrated that most preoperative laboratory testing for low-risk surgical procedures is unnecessary, yet such testing persists. It is time to move beyond this acknowledgment and fix the problem. One large challenge is the lack of knowledge regarding specific combinations of tests, patient conditions, and surgical procedures likely to result in the best outcomes. This was highlighted by the lack of agreement among our surveyed anesthesiology preoperative center directors as to the necessity for most suggested tests. Without such knowledge, Lean Six Sigma would not apply. We think it unlikely that change will come without focused leadership from national organizations encouraging large observational studies linking data from preanesthesia evaluation to patient outcomes. Such studies were recently recommended by Dr. Kevin Tremper in the 49th annual Rovenstine lecture.2

Robert I. Katz, MD

Department of Anesthesiology

University of Florida

Gainesville, FL

Kenneth Rosenfeld, MD

Peter S. A. Glass, MB

Department of Anesthesiology

SUNY at Stony Brook

Stony Brook, New York

Franklin Dexter, MD, PhD

Department of Anesthesia

University of Iowa

Iowa City, Iowa

Franklin-Dexter@UIowa.edu

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REFERENCES

1. Tsai M, Polk JD. The hidden cost of variability. Anesth Analg 2011;113:431
2. Tremper KK. From patient safety to population outcomes: the 49th annual Rovenstine lecture. Anesthesiology 2011;114:755–70
© 2011 International Anesthesia Research Society