Background and Goal of Study: 
The use of routine investigations before elective surgery is widespread during pre anesthesia evaluation. It is considered to determine fitness for anesthesia and identify patients at high risk of postoperative complications. These preoperative investigations may be divided into two categories: routine screening or indicated tests [1].
The aim of this study was to assess the usefulness and cost-effectiveness of routine tests prescribed for pre anesthetic evaluation.
Materials and Methods:
During one month, a prospective study at a university teaching hospital was  conducted. Patients undergoing, a minor to major, elective surgery were included. The results of all routine tests, prescribed by surgeons or anesthesiologist, were noted during the pre anesthesia consultation. Two senior anesthesiologists assessed the abnormality of the findings and validated or not the usefulness of the prescribed exams according to an updated report by the American Society of Anesthesiologists Task Force on pre anesthesia evaluation [1].  
Results:
Of 128 patients included, 60.9% were ASA I physical status and general anesthesia were expected in 75%. In our cohort, 1089 laboratory tests were registered. Only 11.66% of these tests were abnormal. Our study revealed that only 32.5% of the investigations were useful for the pre-anesthetic evaluation. The cost of the routine tests, judged without utility, represented 68.6% of the total cost of all investigations.
Discussion: 
Performing routine screening tests in patients who are otherwise healthy is of little value in detecting diseases or changing anesthetic management and outcome. Several publications reported that the practice of routine investigations involves a sizable cost without a significant benefit for patients. Questioning and physical examination of the patient, followed by few selective tests guided by patient’s health conditions, invasiveness of surgery and potential for blood loss are the best methods to assess anesthetic management and post operative outcome. 
Conclusion(s):
Routine investigations are pricey, often detect minor abnormalities of no clinical relevance, may cause unnecessary delay or cancellation of surgery, and increase medico-legal liability. An approach of selective testing reduces cost without sacrificing safety or quality of perioperative care. 
References (optional):
1- Anesthesiology. 2012;116(3):522-38.
Acknowledgements (optional):
Special thanks to Miss EL MESKINE KHOULOUD.


07 / Pre anesthesia evaluation: routine prescriptions or indicated prescriptions?