{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,22]],"date-time":"2026-03-22T17:52:21Z","timestamp":1774201941372,"version":"3.50.1"},"reference-count":29,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"National Institute of Science and Technology for Health Technology Assessment (IATS) \u2013 CNPq\/Brazil","award":["465518\/2014-1"],"award-info":[{"award-number":["465518\/2014-1"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Low-value preoperative testing before low-risk surgery remains common despite strong evidence discouraging its routine use. This persistent practice generates avoidable waste and potential harm across health systems, particularly in middle-income countries where resources are limited and local evidence is scarce. The objective of this study is to evaluate preoperative care practices, associated costs, and postoperative outcomes in low-risk non-cardiac surgical procedures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective real-world data analysis using administrative claims datasets to evaluate preoperative care in outpatient low-risk surgery reimbursed by a private payer in Brazil (mid-2018 to mid-2023). Adult patients underwent minor urological and gynaecological procedures, as well as video-laparoscopic cholecystectomy or abdominal wall hernia repair. Preoperative consultations, tests, and reimbursement fees were analysed. Primary outcomes included 30-day postoperative events: emergency visits, reinterventions, readmissions, and mortality. Preoperative tests and consultations were assessed to quantify low-value care. The Guidelines and Choosing Wisely Program were used as a reference to define low-value preoperative care. A 50% reduction was modelled to estimate the opportunity cost of reimbursable procedures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 27\u2009678 low-risk surgical procedures, at least one preoperative test was conducted in 57.5% of cases. A total of 87\u2009709 preoperative consultations and 209\u2009697 tests were recorded, with a median of three consultations per procedure. Overall spending on preoperative care totalled BRL 10.88 million, representing a substantial allocation of resources to services with no measurable clinical benefit in a low-risk population. A 50% reduction in potentially unnecessary services could generate savings of BRL 5.44 million, equivalent to funding over 1300 hernia repairs. Despite high testing volumes, clinical outcomes were infrequent: emergency visits occurred in 5.4% of cases, readmissions in 0.9%, reinterventions in 0.2%, and no deaths were reported.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This large real-world study shows substantial overuse of low-value preoperative services in low-risk surgery, without measurable clinical benefit, in a population with very low complication rates. Reducing unnecessary preoperative care offers a clear opportunity for both public and private healthcare organizations to improve efficiency, reduce waste, and optimize resource allocation without compromising patient safety.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/intqhc\/mzag036","type":"journal-article","created":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T12:23:11Z","timestamp":1773058991000},"source":"Crossref","is-referenced-by-count":0,"title":["Low-value preoperative care in low-risk procedures: clinical and economic burden for health system sustainability"],"prefix":"10.1093","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3525-2473","authenticated-orcid":false,"given":"Josiane","family":"Fran\u00e7a John","sequence":"first","affiliation":[{"name":"National Institute of Science and Technology for Health Technology Assessment (IATS)- CNPq\/Brazil (project: 465518\/2014-1) , Porto Alegre,","place":["Brazil"]},{"name":"Program in Cardiovascular Sciences, Federal University of Rio Grande do Sul , Porto Alegre,","place":["Brazil"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ana Paula B S","family":"Etges","sequence":"additional","affiliation":[{"name":"National Institute of Science and Technology for Health Technology Assessment (IATS)- CNPq\/Brazil (project: 465518\/2014-1) , Porto Alegre,","place":["Brazil"]},{"name":"Program in Epidemiology, Federal University of Rio Grande do Sul , Porto Alegre,","place":["Brazil"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Sganzerla","sequence":"additional","affiliation":[{"name":"Program in Epidemiology, Nova Medical School, Nova University Lisbon , Lisbon,","place":["Portugal"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jo\u00e3o","family":"Marques-Gomes","sequence":"additional","affiliation":[{"name":"Nova Medical School, Nova University , Lisbon,","place":["Portugal"]},{"name":"Nova School of Business and Economics , Carcavelos,","place":["Portugal"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marcelo","family":"Miglioranza","sequence":"additional","affiliation":[{"name":"Value Management Office, Private Healthcare Payer Organization , Porto Alegre,","place":["Brazil"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carisi Anne","family":"Polanczyk","sequence":"additional","affiliation":[{"name":"National Institute of Science and Technology for Health Technology Assessment (IATS)- CNPq\/Brazil (project: 465518\/2014-1) , Porto Alegre,","place":["Brazil"]},{"name":"Program in Cardiovascular Sciences, Federal University of Rio Grande do Sul , Porto Alegre,","place":["Brazil"]},{"name":"Program in Epidemiology, Federal University of Rio Grande do Sul , Porto 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