An observational cohort study on pre-operative investigations and referrals: How far are we following recommendations?

Abstract

Background and Aims:Pre-operative investigations are often required to supplement information for risk stratification and assessing reserve for undergoing surgery. Although there are evidence-based recommendations for which investigations should be done, clinical practice varies. The present study aimed to assess the pre-operative investigations and referral practices and compare it with the standard guidelines.Methods:The present observational study was carried out during 2014–appen2015 in a teaching institute after the approval from Institute Ethical Committee. A designated anaesthesiologist collected data from the completed pre-anaesthetic check-up (PAC) sheets. Investigations already done, asked by anaesthesiologists as well as referral services sought were noted and compared with an adapted master table prepared from standard recommendations and guidelines. Data were expressed in frequencies, percentage and statistically analysed using INSTAT software (GraphPad Prism software Inc., La Zolla, USA).Results:Seventy-five out of 352 patients (42.67% male, 57.33% female; American Society of Anesthesiologists physical status I to III) were included in this study. Nearly, all patients attended PAC with at least 5 investigations done. Of them, 89.33% were subjected to at least one unnecessary investigation and 91.67% of the referral services were not required which lead to 3.5 ( SD ±1.64) days loss. Anaesthesiologist-ordered testing was more focused than surgeons.Conclusion:More than two-third of pre-operative investigations and referral services are unnecessary. Anaesthesiologists are relatively more rational in ordering pre-operative tests yet; a lot can be done to rationalise the practice as well as reducing healthcare cost.

Abnormal routine pre-operative test results and their impact on anaesthetic management: An observational study

“…[ 5 ] This leads to many unnecessary or unindicated tests and a huge cost burden. [ 6 7 ] The present study also found similar results. More than 60% of anaesthesiologist and more than 70% of surgeons believe that pre-operative tests will detect a hidden abnormality.…”

Preoperative laboratory testing - Comparison of National Institute of Clinical Excellence guidelines with current practice - An observational study

“…The practice of ‘routine’ investigation has been questioned by several studies. [345] Prevalence of abnormal results in routine preoperative tests is around 5-60% although it may vary with the American Society of Anesthesiologists Physical status of patients. [56789] Studies that have focused on ASA 1 and 2 patients, report very low prevalence (0.8%) of abnormalities.…”

“…The consensus of these guidelines is that unnecessary tests may lead to extra cost burden, delay in surgery and occasional harm to the patient. [34] It is possible that these guidelines may not entirely be applicable to the Indian population. The present study was aimed to compare the preoperative laboratory investigations ordered in a referral medical college hospital of South India with the National Institute of Clinical Excellence (NICE) guidelines.…”

Practice and reasons for routine pre-operative investigations among anaesthesiologists and surgeons: An online survey

“…[ 3 ] However, the practice of routine pre-operative tests before elective surgery has remained widely prevalent. [ 4 5 ] Health-care practices not only depend on practitioners' knowledge but also on the local laws, protocols, administrative policies, etc. The present study was aimed to assess the reasons behind this continued practice.…”