Choosing wisely in anesthesiology: The gap between evidence and practice

Onyi C. Onuoha, Valerie A. Arkoosh, Lee A. Fleisher

Research output: Contribution to journalReview articlepeer-review

40 Scopus citations


To develop a "top-five" list of unnecessary medical services in anesthesiology, we undertook a multistep survey of anesthesiologists, most of whom were in academic practice, and a consequent iterative process with the committees of the American Society of Anesthesiologists.We generated a list of 18 low-value perioperative activities from American Society of Anesthesiologists practice parameters and the literature. Starting with this list and proceeding with a 2-step survey using a 5-point Likert scale questionnaire, we eventually identified 5 common activities that are of low quality or benefit and high cost and have poor evidence supporting their use. The 2 preoperative practices in the top-five list addressed the avoidance of unindicated baseline laboratory studies or diagnostic cardiac stress testing. The 3 intraoperative practices involved the avoidance of the routine use of the pulmonary artery for cardiac surgery and the use of packed red blood cells or colloid when not indicated.

Original languageEnglish (US)
Pages (from-to)1391-1395
Number of pages5
JournalJAMA internal medicine
Issue number8
StatePublished - Aug 2014

ASJC Scopus subject areas

  • Internal Medicine


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