Patients undergoing blood tests before minor/moderate trauma surgery: a retrospective review

Abstract

ObjectiveThe aim of this study was to establish the number of unnecessary preoperative blood tests undertaken on ASA Grade 1 patients undergoing minor/moderate orthopaedic trauma surgery.DesignReview of all ASA1 patients who had been operated on the trauma lists for three consecutive months.SettingUK Teaching Hospital.ParticipantsPatients with ages ranging between 16 and 60 years, and undergoing a minor or moderate trauma operation.Main outcome measuresThe type and number of blood tests were established and any abnormal results were checked for clinical significance and whether the result altered patients' management. The cost of each blood test was calculated so that potential savings could be identified.ResultsA total of 127 patients (60 males, 67 females, average age 34) fulfilled our inclusion criteria. Ninety-five patients (75%) had either one or more preoperative blood tests of which 41% were abnormal but of no clinical significance.ConclusionFrom the results of our study, we conclude that preoperative blood tests are unnecessary in Grade 1 ASA patients undergoing minor/moderate orthopaedic trauma surgery. Unnecessary blood tests can waste time, money, resources and overburden laboratory staff.

Blood tests: One too many? Evaluating blood requesting guidance developed for acute patients admitted to trauma and orthopaedic units

“…This study is limited by the fact the relationship between blood requesting and overall mortality and morbidity was not investigated The literature however demonstrates that, in scheduled patients, management is unlikely to be influenced by blood tests particularly in healthy patients [3]. In a systematic review of preoperative testing by Munro et al, aberrations in haematology, haemaostasis tests and biochemistry changed the management of fewer than 1% of patients [15].…”

Routine Preoperative Laboratory Tests for Elective Surgery

“…Trials in children and many studies in adults support the need for selectivity for the tests to be performed in elective and non-cardiac surgery. 3,4 Those studies concluded that many and unnecessary preoperative tests have been used that increased the costs of the procedures. 3,4 Performing whole blood count preoperatively is a widely accepted opinion.…”

Low value Injury Care in the Adult Orthopaedic Trauma Population: A Systematic Review

“…Most studies were based on case series (n=33) 22,31,33,34,36,38,41,[43][44][45][46][47][48][49][50]56,57,[60][61][62][63][64]66,[68][69][70][71][72]74,75,7785,89,90 followed by systematic reviews with or without meta-analysis (n=12) [23][24][25]28,29,39,53,59,67,78,83,86,88,91 , prospective cohorts (n=9) 30,32,35,37,42,…”

“…52,58 Methodological Quality of the Studies Studies focusing on initial diagnostic imaging were mostly of low to moderate quality or had serious to critical risk of bias (Table 2). One study on preoperative blood tests in ASA grade I patients respected 9/10 cases series quality criteria 22 , while another met half of these criteria. 38 Among studies on initial consultation and therapeutic interventions (Table 3), those on spine consultation after a thoracolumbar transverse process fracture had serious risk of bias.…”

“…X-ray or CT). We also identified two case series 22,38 evaluating routine pre-operative blood tests in American Society of Anaesthesiologist (ASA) grade I patients. Studies reported injuries would have been missed in [?]…”