Van Gelder et al.1 demonstrated that a huge variety exists in the practice of preoperative evaluation throughout European countries. Not surprisingly, only half of the respondents reported ordering tests in accordance with guidelines and routine testing still is a common habit in certain countries.
Data of this study were collected in 2009. Since then, a number of newly developed guidelines and practice advisories have been published.2–4 The guideline from the European Society of Anaesthesiology3 needs special attention as the authors stated that the survey was supported by the European Society of Anaesthesiology and distributed to associated national societies. Thus, the findings of this survey have to be interpreted with caution as respondents might have been influenced by this guideline.
Another concern is that large European countries like France, Italy, Sweden, Norway and Russia were not represented within the study. Interestingly, Austria, Switzerland and Lichtenstein contributed by providing 15% of the data analysed. The large proportion of contributions from these small European countries could be the result of an intense discussion of preoperative evaluation there. For Austria, it has to be mentioned that a high-quality nationwide guideline on preoperative evaluation has been recently introduced recently.5
The authors report that nearly 20% of the participants would have no concerns if routine testing was eliminated. This implies that maybe up to 80% would have concerns. For certain clinical conditions, such as minor procedures like cataract surgery, evidence for eliminating preoperative testing is strong.6 In consequence, evidence-based guidelines could play a major rule in the perioperative process. As van Gelder et al.1 state in their discussion section, the introduction of guidelines is challenging and the distribution of guidelines is still disappointing. We have recently concluded a healthcare project by involving an electronic decision tool for the dissemination of a preoperative guideline in Austria. Data of this project are in the publication process and the findings are promising. Our study group has just recently shown what an enormous economic impact such a system could have.7
The recognition of the importance and the daily practice of preoperative evaluation are in a state of changing paradigms. The study by van Gelder et al. must be seen as a significant contribution to the ongoing discussion of eliminating routine testing and promoting selective, evidence-based preoperative testing.
Assistance with the letter: none reported.
Financial support and sponsorship: none reported.
Conflicts of interest: none reported.
Comment from the Editor: the authors of the European survey on preoperative testing did not wish to respond to this letter.
1. van Gelder FE, de Graaff JC, van Wolfswinkel L, van Klei WA. Preoperative testing in noncardiac surgery patients: a survey amongst European anaesthesiologists. Eur J Anaesthesiol
2. Preoperative evaluation of adult patients prior to elective, non-cardiac surgery: joint recommendations of German Society of Anesthesiology and Intensive Care Medicine, German Society of Surgery and German Society of Internal Medicine. Anaesth Intensivmed
3. De Hert S, Imberger G, Carlisle J, et al Preoperative evaluation of the adult patient undergoing noncardiac surgery: guidelines from the European Society of Anaesthesiology. Eur J Anaesthesiol
4. Apfelbaum JL, Connis RT, Nickinovich DG, et al Practice advisory for preanesthesia evaluation: an updated report by the American Society of Anesthesiologists Task Force on Preanesthesia Evaluation. Anesthesiology
6. Schein OD, Katz J, Bass EB, et al The value of routine preoperative medical testing before cataract surgery. Study of Medical Testing for Cataract Surgery. N Engl J Med
7. Flamm M, Fritsch G, Seer J, et al Nonadherence to guidelines for preoperative testing in a secondary care hospital in Austria: the economic impact of unnecessary and double testing. Eur J Anaesthesiol