An alternative approach is the 6 min walk, which has been suggested as both an assessment of preoperative activity of daily living as well as a standard postoperative recovery score [5].

Aside for a complete blood count and complete metabolic profile, routine laboratory studies are rarely useful in the absence of specific patient risk factors [6]. There is considerable data supporting the contention that preoperative testing is expensive, with current estimates suggesting that this area alone accounts for 10 % of the more than $30 billion spent on laboratory testing annually [7]. Korvin et al. 13 reviewed the screening test results of almost 20,000 tests performed on 1,000 and determined that of the almost 20,000 tests 2,223 abnormal results were identified [8]. However, 675 had been predicted on clinical assessment, 1,325 abnormalities did not yield new diagnoses, and 223 led to 83 new diagnoses in 77 patients (none of which were deemed clinically significant) [8]. A similar analysis of 2,000 patients selected randomly from a database of patients screened for elective surgery determined that of 2,785 preoperative admissions tests studied (1,828 not indicated), only 96 were abnormal (10 unanticipated; 4 clinically significant) [9]. The same concern exists regarding the role of screening chest x-rays in patients without cancer or clinical risk factors. Rucker et al. assessed 872 patients with screen chest x-ray, and found serious abnormalities in only 1/368 patients without risk factors compared to 22 % of patients with risk factors (all predicted based on history) [10]. Michota, recommended a patient-centric strategy for additional testing and this reference is strongly recommended to the reader [11]. The available data suggests that each institution assess its cost-effective strategy for assessing patient risk and potential preoperative risk reduction to avoid unnecessary cost.