(HealthDay News) — For patients undergoing midurethral sling surgery, preoperative testing frequently does not adhere to national guidelines, according to a study published in The Journal of Urology.

Tom S. Feng, MD, from the Cedars-Sinai Medical Center in Los Angeles, and colleagues estimated the effect of overuse of preoperative testing on health care costs. They reviewed data for women who underwent sling surgery (with or without concomitant prolapse repair) between 2012 and 2013. Based on summary guidelines from the American Academy of Family Physicians, physician orders for preoperative electrocardiogram, chest X-ray, basic metabolic panel, complete blood count, coagulation studies, and urinalysis were classified as appropriate or inappropriate.

The researchers identified 101 women who underwent midurethral sling surgery and 346 preoperative test orders. Overall, there was no appropriate clinical indication for 76% of coagulation profiles, 73% of complete blood counts, 47% of basic metabolic panels, 39% of chest X-rays, and 21% of electrocardiograms ordered. Despite an appropriate clinical indication, 6% of electrocardiograms, 22% of chest X-rays, and 10% of urinalyses were not ordered. For the cohort the estimated charges of overused tests were $1,844.15 ($18 per patient).

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“Preoperative testing is overused as well as underused in patients undergoing sling surgery,” the authors write. “Poor adherence to national guidelines leads to increased health care costs and warrants increased awareness in following evidence-based guidelines.”

One author disclosed financial ties to Boston Scientific.


  1. Feng TS, Perkins CE, Wood LN, et al. Preoperative Testing for Urethral Sling Surgery for Stress Urinary Incontinence: Overuse, Underuse and Cost Implications. J Urol. doi: 10.1016/j.juro.2015.07.110.