Preoperative Laboratory Testing in Patients Undergoing Elective, Low-Risk Ambulatory Surgery

Abstract

Background Routine preoperative laboratory testing for ambulatory surgery is not recommended. Methods Patients who underwent elective hernia repair (N = 73,596) were identified from the National Surgical Quality Improvement Program (NSQIP) database (2005–2010). Patterns of preoperative testing were examined. Multivariate analyses were used to identify factors associated with testing and postoperative complications. Results A total of 46,977 (63.8%) patients underwent testing, with at least one abnormal test recorded in 61.6% of patients. In patients with no NSQIP comorbidities (N = 25,149) and no clear indication for testing, 54% received at least one test. In addition, 15.3% of tested patients underwent laboratory testing the day of the operation. In this group, surgery was done despite abnormal results in 61.6% of same day tests. In multivariate analyses, testing was associated with older age, ASA (American Society of Anesthesiologists) class >1, hypertension, ascites, bleeding disorders, systemic steroids, and laparoscopic procedures. Major complications (reintubation, pulmonary embolus, stroke, renal failure, coma, cardiac arrest, myocardial infarction, septic shock, bleeding, or death) occurred in 0.3% of patients. After adjusting for patient and procedure characteristics, neither testing nor abnormal results were associated with postoperative complications. Conclusions Preoperative testing is overused in patients undergoing low-risk, ambulatory surgery. Neither testing nor abnormal results were associated with postoperative outcomes. On the basis of high rates of testing in healthy patients, physician and/or facility preference and not only patient condition currently dictate use. Involvement from surgical societies is necessary to establish guidelines for preoperative testing.

Paciente Adulto Mayor Y Cirugía No Cardíaca: ¿qué Debemos Saber?

“…Sin embargo, se justifica realizar electrocardiograma a los pacientes mayores de 65 años con el fin de identificar una posible comorbilidad cardiovascular severa 5,15 . También hay consenso en medir creatininemia, hematocrito/hemoglobina y electrolitos plasmáticos en los pacientes con edad avanzada (mayores a 65 años), como lo recomienda la ASA y el Ontario Preoperative Testing Group 16 . Solicitar pruebas de coagulación y recuento plaquetario de manera rutinaria no ha demostrado ser efectivo en cambiar la conducta perioperatoria, sin embargo, se deben realizar cuando el paciente tenga manifestaciones clínicas sugerentes de alteraciones de la coagulación y/o tratamiento anticoagulante oral o sistémico 17 .…”

Adopting Information Management Based Joint Preoperative Assessment and Risk Stratification Model to Save Surgical Care Cost

“…However, studies show that the practice has not changed to 'individualized / patients char- acteristic' from 'routine' and that preoperative testing is more strongly associated with provider practice patterns than with patient characteristics [11] . A study reviewing data from National Surgical Quality Improvement Program database found that neither laboratory testing nor abnormal results were associated with postoperative complications [12] . Many a time, we try to find some hidden abnormality by using routine preoperative testing.…”

Analysis of pre-operative aspartate aminotransferase and alanine aminotransferase in 14,185 pediatric patients

“…Although aspartate aminotransferase (AST) and alanine aminotransferase (ALT) tests are indicators of hepatic cell injury, rather than reflecting hepatic function, they are considered core components of liver function test and are performed as a common pre-anesthetic laboratory test [2]. In a previous cohort study of 73,596 patients undergoing elective, low-risk ambulatory surgery, abnormal pre-anesthetic laboratory findings were not predictive of postoperative outcomes when compared with normal results [3]. Several studies have investigated the usefulness of preoperative screening tests in adult patients [4][5][6], however, there are scarce data for evaluation of routine pre-anesthetic AST and ALT testing in pediatric patients.…”