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Avoid colorectal cancer screening tests in asymptomatic patients with a life expectancy of less than 10 years and with no personal or family history of colorectal neoplasia.
Choosing Wisely Canada
Canadian Association of General Surgeons
The aim of screening investigations for colorectal cancer, such as fecal immunochemical test (FIT) and colonoscopy, is to reduce deaths through early detection and removal of polyps (a precursor to colon cancer) and early stage colorectal cancers. While colonoscopy is a safe screening modality, increased risks have been associated with advanced age and comorbidities. Life expectancy, presence of symptoms, personal and family history, previous investigations, and patient preference must all be ...
ver más ... 2020Routine preoperative chest x-rays and baseline laboratory studies, such as complete blood count, metabolic panel, or coagulation studies, should not be obtained in patients undergoing low-risk ...
Choosing Wisely Canada
Canadian Association of General Surgeons
Obtaining routine preoperative radiological and laboratory testing offers little value to the perioperative care of asymptomatic patients undergoing low-risk surgery. Evidence suggests that abnormal results within this setting rarely affect management or change clinical outcomes. Instead, a focused history and physical examination should be performed to identify which preoperative investigations are required. Where preoperative testing may add value is in the setting of symptomatic patients or ...
ver más ... 2020Don’t use computed tomography (CT) for the evaluation of suspected appendicitis in pediatric patients until an ultrasound has been considered as an option.
Choosing Wisely Canada
Canadian Association of General Surgeons
Ultrasound is an accurate and cost-effective imaging modality for initial evaluation of suspected appendicitis in the pediatric population. Evidence shows that the sensitivity and specificity of ultrasound is high with reports of up to 95%, though this may vary based on center experience and capabilities. Where findings on ultrasound exam are equivocal, CT can be considered as part of a step-up investigative approach after discussion with the patient and caregivers about risks of childhood ...
ver más ... 2020Consider a watchful waiting approach in patients with asymptomatic or minimally symptomatic inguinal hernias.
Choosing Wisely Canada
Canadian Association of General Surgeons
For minimally symptomatic hernias, surgical repair can prevent potential complications of hernia incarceration and strangulation, but the risk of post-operative complications from infection, hernia recurrence, and chronic inguinal pain approaches the overall risks of incarceration. Watchful waiting for asymptomatic or minimally symptomatic inguinal hernias is a safe option for carefully selected patients and does not preclude patients from undergoing elective repair should discomfort worsen.
ver más ... 2020Do not transfuse red blood cells to patients with burn injuries who have haemoglobin levels greater than 70 g/l, unless there is active haemorrhage or myocardial ischaemia.
Choosing Wisely Canada
Burns Canada
Blood products are a limited resource. Blood transfusion is associated with adverse effects, including transfusion reactions, immunosuppression, lung injury, and circulatory overload. In the context of stable patients with burn injuries, who are not actively bleeding or with active myocardial ischaemia, the current evidence supports a restrictive transfusion trigger to maintain haemoglobin above 70g/l. Unnecessary transfusions can also be avoided by ordering and infusing one unit of red blood ...
ver más ... 2020