Ruin your routine.

August 11, 2017. We all do it: order a panel of labs prior to every procedure big and small. But in patients with no clinical indicator of abnormality, are routine labs routinely useless? The answer, at least for cataract surgery, is yes. Pre-op labs for low risk procedures do not change management and add to patient anxiety and cost. So the National Institute for Health and Care Excellence developed official guidelines for when (and when not) to order “routine” labs prior to a procedure, available as of this week in JAMA. The recs hinge primarily on ASA grade and invasiveness of procedure. The summary: healthy patients require no labs unless preparing for a “major” surgery (think overnight stay), renal function and CBC are sufficient for unhealthy patients prior to any surgery and for anyone prior to major surgery, and coags are really only indicated for unhealthy patients on anticoagulation or with chronic liver disease. So ditch one bad routine and pick up a good one. How about gardening?