Estimation of the Overuse of Preoperative Chest X-rays According to “Choosing Wisely”, “No Hacer”, and “Essencial” Initiatives: Are They Equally Applicable and Comparable?

Jorge Vicente-Guijarro, José Lorenzo Valencia-Martín, Paloma Moreno-Nunez, Pedro Ruiz-López, José Joaquín Mira-Solves, Jesús María Aranaz-Andrés and Working Group Sobrina
Additional contact information
Jorge Vicente-Guijarro: Servicio de Medicina Preventiva y Salud Pública, Hospital Universitario Ramón y Cajal, IRYCIS, 28034 Madrid, Spain
José Lorenzo Valencia-Martín: Instituto Ramón y Cajal de Investigación Sanitaria, IRYCIS, 28034 Madrid, Spain
Paloma Moreno-Nunez: Servicio de Medicina Preventiva y Salud Pública, Hospital Universitario Ramón y Cajal, IRYCIS, 28034 Madrid, Spain
Pedro Ruiz-López: Facultad de Ciencias de la Salud, Universidad Internacional de la Rioja, 26006 Logroño, La Rioja, Spain
José Joaquín Mira-Solves: Health Psychology Department, Miguel Hernández University, 03202 Elche, Spain
Jesús María Aranaz-Andrés: Servicio de Medicina Preventiva y Salud Pública, Hospital Universitario Ramón y Cajal, IRYCIS, 28034 Madrid, Spain
Working Group Sobrina: Members are listed at the Acknowledgments.

IJERPH, 2020, vol. 17, issue 23, 1-18

Abstract: Background: Overuse reduces the efficiency of healthcare systems and compromises patient safety. Different institutions have issued recommendations on the indication of preoperative chest X-rays, but the degree of compliance with these recommendations is unknown. This study investigates the frequency and characteristics of the inappropriateness of this practice. Methods: This is a descriptive observational study with analytical components, performed in a tertiary hospital in the Community of Madrid (Spain) between July 2018 and June 2019. The inappropriateness of preoperative chest X-ray tests was analyzed according to “Choosing Wisely”, “No Hacer” and “Essencial” initiatives and the cost associated with this practice was estimated in Relative Value and Monetary Units. Results: A total of 3449 preoperative chest X-ray tests were performed during the period of study. In total, 5.4% of them were unjustified according to the “No Hacer” recommendation and 73.3% according to “Choosing Wisely” and “Essencial” criteria, which would be equivalent to 5.6% and 11.8% of the interventions in which this test was unnecessary, respectively. One or more preoperative chest X-ray(s) were indicated in more than 20% of the interventions in which another chest X-ray had already been performed in the previous 3 months. A higher inappropriateness score was also recorded for interventions with an American Society of Anesthesiologists (ASA) grade ? III (16.5%). The Anesthesiology service obtained a lower inappropriateness score than other Petitioning Surgical Services (57.5% according to “Choosing Wisely” and “Essencial”; 4.1% according to “No Hacer”). Inappropriate indication of chest X-rays represents an annual cost of EUR 52,122.69 (170.1 Relative Value Units) according to “No Hacer” and EUR 3895.29 (2276.1 Relative Value Units) according to “Choosing Wisely” or “Essencial” criteria. Conclusions: There was wide variability between the recommendations that directly affected the degree of inappropriateness found, with the main reasons for inappropriateness being duplication of preoperative chest X-rays and the lack of consideration of the particularities of thoracic interventions. This inappropriateness implies a significant expense according to the applicable recommendations and therefore a high opportunity cost.

Keywords: medical overuse; practice guidelines as topic; preoperative care; diagnostic tests; routine; anesthesia department; hospital (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2020
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