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. 2025 Oct 1;8(10):e2535750.
doi: 10.1001/jamanetworkopen.2025.35750.

Right-Sizing Testing Before Elective Surgery for Patients With Low Risk

Nicole M Mott  1   2   3 , Dana Greene Jr  4 , Erin Kim  3   5 , Valerie Mefford  4 , Anthony Cuttitta  4 , Faelan Jacobson-Davies  3 , Shawna N Smith  5   6 , Eve A Kerr  2   7 , Anthony L Edelman  8 , Michael Mathis  8 , Michael Englesbe  3   9 , Hari Nathan  3   9 , Lesly A Dossett  3   4   9
Affiliations

Right-Sizing Testing Before Elective Surgery for Patients With Low Risk

Nicole M Mott et al. JAMA Netw Open. .

Abstract

Importance: Guidelines recommend against testing before low-risk surgery in healthy patients because it offers no benefit and may cause harm. However, testing remains prevalent, highlighting the need for a deimplementation strategy that can be broadly applied across health care settings.

Objective: To assess the feasibility of a multifaceted, multicomponent deimplementation strategy entitled Right-Sizing Testing Before Elective Surgery (RITE-Size), hypothesizing it would be feasible to execute with 80% of milestones met on time.

Design, setting, and participants: This quality improvement study was conducted from March 1 to August 31, 2024, at 3 hospitals of varying characteristics in Michigan. The intervention was structured into 3 phases (baseline, preparation, and active deimplementation) and further divided into 6 milestones (ie, key steps in the deimplementation process). Eligible preoperative tests included bloodwork and cardiopulmonary evaluations (eg, blood cell counts, metabolic panels, chest radiography, and electrocardiography) performed within 30 days of elective laparoscopic cholecystectomy, inguinal hernia repair, or breast lumpectomy in healthy adults.

Interventions: The intervention included site visits, coaching sessions, data review, initiation of consensus processes for deimplementation, and distribution of strategy components (eg, decision support tools).

Main outcomes and measures: The primary outcome was milestone completion. Secondary outcomes included acceptability and appropriateness, as assessed by the Acceptability of Intervention Measure (AIM) and the Intervention Appropriateness Measure (IAM). Additionally, barriers and facilitators to implementation were evaluated through semistructured interviews, along with testing rates derived from claims data.

Results: A total of 203 patients (mean [SD] age, 57 [17] years; 117 [57.6%] female) who underwent procedures of interest were identified. All milestones were achieved on time. The intervention had high acceptability and appropriateness among stakeholders (median [IQR], 20 of 20 [18-20] for AIM and 20 of 20 [16-20] for IAM). Key facilitators included small, cohesive, perioperative teams and the incorporation of the intervention into policy, supported by auditing and feedback systems. Barriers included the need for ongoing education and coordination across large health care systems. Testing rates significantly decreased across all sites from 68.0% (51 of 75) to 40.3% (25 of 62) (P = .001).

Conclusions and relevance: This quality improvement study of a multifaceted, multicomponent deimplementation strategy to reduce unnecessary preoperative testing at diverse hospital sites demonstrated feasibility of expanding this work in a stepped-wedge cluster randomized trial. These results suggest that hospital systems can use this deimplementation strategy in the future to reduce unnecessary preoperative testing.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Kerr reported receiving grants from Veterans Affairs Health Services Research & Development and the National Institutes of Health outside the submitted work and working as a consultant for the National Committee for Quality Assurance. Dr Edelman reported receiving grants from the Department of Health and Human Services during the conduct of the study. Dr Mathis reported receiving grants from the National Institutes of Health and Chiesi USA outside the submitted work. Dr Nathan reported receiving support from Blue Cross Blue Shield of Michigan. No other disclosures were reported.

Figures

Figure.
Figure.. Michigan Value Collaborative (MVC) Testing Rates by Month Across All 3 Sites From March 2024 (Month 1) to August 2024 (Month 6)
See this image and copyright information in PMC

Comment in

  • doi: 10.1001/jamanetworkopen.2025.35756

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