Perioperative practices often mired in inertia

Regarding Janet Colwell's piece in the April 2025 I.M. Matters (“Primary Care Preps Patients Perioperatively”), kudos for the stress on primary care involvement with perioperative care and for highlighting updated approaches to evaluation and management.

However, it's important to further highlight the frustration of many primary care physicians when unnecessary tests are included in the “routine pre-op testing battery.” More often than not, our opinions are neither sought nor welcomed when pre-op orders are generated by hospitals and outpatient surgical centers. “Routine” pre-op tests such as EKGs, urinalyses, and coagulation profiles are often insisted upon, despite the lack of evidence that they will change management. My experience has been that this situation is worse in stand-alone surgery centers for plastic surgery and ophthalmologic procedures.

As suggested in the article, I have, on multiple occasions, gently pushed back when unneeded tests are demanded. Typically, the response from the surgical team is, “Either do the tests or we won't do the procedure.” My staff has become adept at calling patients to return for repeat testing when an initial (frequently nonindicated) test comes back abnormal. Additionally, when we extend the courtesy of actually ordering the test for our patients, we will often then need to justify the cost to their insurance companies.

Evidence-based progress in perioperative management is welcomed. I would also welcome an open-minded approach by institutions that, mired in inertia, are unwilling to change practices for which no evidence exists.

Eric C. Last, DO, FACP
Wantagh, N.Y.