• Kyle R Kirkham, Duminda N Wijeysundera, Ciara Pendrith, Ryan Ng, Jack V Tu, Andrew S Boozary, Joshua Tepper, Michael J Schull, Wendy Levinson, and R Sacha Bhatia.
• From the Department of Anesthesia and Pain Management, Toronto Western Hospital, Toronto, Ontario, Canada (K.R.K.); Department of Anesthesia, Women's College Hospital, Toronto, Ontario, Canada (K.R.K.); Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada (D.N.W.); Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada (D.N.W.); Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada (D.N.W., J.V.T., J.T., M.J.S., R.S.B.); Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (D.N.W., R.N., J.V.T., M.J.S., R.S.B.); Institute for Health System Solutions, Women's College Hospital, Toronto, Ontario, Canada (C.P., R.S.B.); Department of Medicine, University of Toronto, Toronto, Ontario, Canada (J.V.T., M.J.S., W.L., R.S.B.); Division of Cardiology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (J.V.T.); Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts (A.S.B.); Health Quality Ontario, Toronto, Ontario, Canada (J.T.); Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada (J.T.); Department of Emergency Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (M.J.S.); and Department of Cardiology, Women's College Hospital, Toronto, Ontario, Canada (R.S.B.).
• Anesthesiology. 2016 Apr 1; 124 (4): 804-14.

BackgroundIncreasing attention has been focused on low-value healthcare services. Through Choosing Wisely campaigns, routine laboratory testing before low-risk surgery has been discouraged in the absence of clinical indications. The authors investigated rates, determinants, and institutional variation in laboratory testing before low-risk procedures.MethodsPatients who underwent ophthalmologic surgeries or predefined low-risk surgeries in Ontario, Canada, between April 1, 2008, and March 31, 2013, were identified from population-based administrative databases. Preoperative blood work was defined as a complete blood count, prothrombin time, partial thromboplastin, or basic metabolic panel within 60 days before an index procedure. Adjusted associations between patient and institutional factors and preoperative testing were assessed with hierarchical multivariable logistic regression. Institutional variation was characterized using the median odds ratio.ResultsThe cohort included 906,902 patients who underwent 1,330,466 procedures (57.1% ophthalmologic and 42.9% low-risk surgery) at 119 institutions. Preoperative blood work preceded 400,058 (30.1%) procedures. The unadjusted institutional rate of preoperative blood work varied widely (0.0 to 98.1%). In regression modeling, significant predictors of preoperative testing included atrial fibrillation (adjusted odds ratio [AOR], 2.58; 95% CI, 2.51 to 2.66), preoperative medical consultation (AOR, 1.68; 95% CI, 1.65 to 1.71), previous mitral valve replacement (AOR, 2.33; 95% CI, 2.10 to 2.58), and liver disease (AOR, 1.69; 95% CI, 1.55 to 1.84). The median odds ratio for interinstitutional variation was 2.43.ConclusionsResults of this study suggest that testing is associated with a range of clinical covariates. However, an association was similarly identified with preoperative consultation, and significant variation between institutions exists across the jurisdiction.

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