Reducing unnecessary preoperative testing in Day Surgery: a Choosing Wisely-based quality improvement study

Routine preoperative laboratory testing is widely performed despite strong evidence and international guidelines indicating limited value for healthy patients undergoing low-risk surgery. Overuse contributes to unnecessary costs, delays, and potential patient harm through false positives and cascades of care.Objective To evaluate the impact of a Choosing Wisely-based preoperative assessment model on testing rates, surgical delays, safety outcomes, and system efficiency in a Day Surgery setting.Design, setting, and participants This is a retrospective pre-post quality improvement study conducted at a tertiary academic hospital in Italy. Two cohorts of adult Day Surgery patients were compared: A pre-intervention group (June 2022-June 2023) and a post-intervention group following implementation of a redesigned preoperative pathway (July 2023-July 2024). Intervention It involves the implementation of a new preoperative model separating minor Day Surgery cases (ASA I-III) from intermediate/major surgery, eliminating routine testing unless clinically indicated after anesthesiologist evaluation. Main outcomes and measures These are proportion of patients receiving laboratory tests, ECG, or chest radiography, rate of surgery cancellations or delays, need for postoperative admission, time from anesthesiology visit to surgery, and estimated cost reduction. Results A total of 1059 patients formed the pre-intervention group and 1790 the post-intervention group. After implementation, testing decreased substantially: laboratory testing dropped to 2.6%, ECG to 6.7%, and chest radiography to 0.3%. No surgeries were cancelled due to insufficient work-up. No unplanned postoperative admissions occurred. Wait times were dramatically reduced from weeks to less than 7 days, eliminating previous structural bottleneck.Conclusions and relevance A Choosing Wisely aligned preoperative pathway safely reduced unnecessary testing, improved efficiency, shortened wait times, and lowered costs. This approach is scalable and may inform national policy and Value-Based Health Care strategies.