Selective versus routine preoperative testing in minor gynecologic surgical procedures: A two-center comparative cohort study of perioperative outcomes and resource utilization

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Background Routine preoperative testing remains common in minor gynaecological surgery, offering opportunities to reduce costs by avoiding unnecessary tests. Objectives To compare the clinical safety and cost impact of selective versus routine preoperative laboratory testing in women undergoing minor gynecologic surgical procedures. Methods Retrospective two-center comparative cohort study in two tertiary gynecologic centers adopting different preoperative testing policies. A total of 5,240 consecutive women undergoing elective minor gynecologic surgical procedures for benign gynecologic pathology were included. Patients were managed according to two different preoperative strategies: routine laboratory testing (Roma cohort) and selective testing based on clinical assessment and comorbidity (Udine cohort). The study aims to compare perioperative outcomes and healthcare costs between routine and selective preoperative testing strategies. Outcomes Intraoperative and postoperative complications, healthcare costs in two groups. Results Postoperative complications were infrequent in both cohorts and did not differ significantly between routine and selective testing strategies (p = 0.345). In multivariable logistic regression analysis, selective testing was not independently associated with postoperative complications (p = 0.345). Independent predictors of complications included age (p = 0.041), ASA score ≥3 (p = 0.021), and operative time (p = 0.050). Selective testing was associated with a significant reduction in preoperative laboratory costs without negatively affecting perioperative safety. Conclusion In minor gynecologic surgical procedures, selective preoperative laboratory testing based on clinical evaluation appears to be as safe as routine testing while reducing healthcare expenditures. What is new? A more tailored and guideline-concordant preoperative assessment strategy in minor gynecologic surgery may reduce healthcare expenditure.

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