Abstract Body (Do not enter title and authors here):
Introduction: Low-value preoperative care before low-risk surgeries remains common, despite consistent evidence showing minimal benefit. The problem is even more relevant in middle-income countries, where healthcare budgets are constrained and local data are scarce.

Objectives: To assess the utilization and reimbursement patterns of preoperative care and to examine postoperative outcomes in low-risk non-cardiac surgical procedures.

Methods: We conducted a retrospective cohort study using clinical and administrative data from a public academic hospital (2015-2019) and a private payer (2018-2023) dataset in Brazil. Data from low-risk surgeries, including orthopedic, gynecologic, ophthalmologic, abdominal wall repairs, laparoscopic cholecystectomy, and vasectomy, were collected. Preoperative consultations, tests, and reimbursement fees were analyzed. Primary outcomes included 30-day postoperative events: emergency visits, reinterventions, readmissions, and mortality. Preoperative exams and consultations were assessed to quantify low-value care. The Choosing Wisely Program was used as a reference to define low-value preoperative care. A 50% reduction was modeled to estimate the opportunity cost of reimbursable procedures.

Results: A total of 38,389 low-risk surgeries were analyzed, 10,711 in the public and 27,678 in the private system. In the public cohort, 33,683 consultations and 61,299 tests were conducted, with at least one test in 62% of cases. In the private cohort, there were 87,709 consultations and 209,697 tests, with 57% of procedures preceded by testing. Most tests were laboratory-based: 88% in the public and 95% in the private system; cardiac evaluations accounted for 7% and 4%, respectively. Clinical outcomes were low in both settings: 0.5% emergency visits, 1% reinterventions, 3.6% readmissions, and 0.08% mortality in the public, and 5.4% emergency visits, 0.9% readmissions, 0.2% reinterventions, and no deaths in the private. A 50% reduction in low-value preoperative care could fund ~500 cataract surgeries in the public system and enable 1,300+ hernia repairs in the private sector.

Conclusions and Relevance: This study reveals substantial use of low-value preoperative care in a middle-income country. Despite high testing volumes, clinical outcomes were favorable, reinforcing the limited utility of routine preoperative testing in low-risk surgeries. These findings highlight opportunities to reduce waste and improve system efficiency.