Preoperative testing in elective surgery: Is it really cost effective?

Ranasinghe, Priyanga; Perera, YS; Senaratne, Jaswarlal; Abayadeera, Anuja

doi:10.4103/0259-1162.84177

Cited by 13 publications

(16 citation statements)

References 11 publications

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“…The present study shows similar, if not worse, findings as compared to the study done in Srilanka. [ 20 ] The mentioned study found very poor compliance to the local recommendations for CXRs, coagulation profiles, liver enzymes and 2D ECHO. Another retrospective review found that 100% of the patients had many routine investigations done, but there was no change in the plan of anaesthesia in any of these cases despite having 32.5% abnormal test results for some of the tests.…”

Section: Discussionmentioning

confidence: 95%

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

2016

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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.

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Section: Discussionmentioning

confidence: 95%

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

2016

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“…It is possible that these less experienced anaesthesiologists and surgeons might be more likely to request unnecessary preoperative tests. 11 Lastly, the majority of patients who attend higher-level facilities, such as IALCH, are complex cases that require specialised care. 12 These patients are likely to have existing mild-to-severe systemic disease (ASA grade II-IV), which would automatically qualify them for routine preoperative U&E testing according to the NICE preoperative testing guidelines.…”

Section: Discussionmentioning

confidence: 99%

An audit of unnecessary preoperative urea and electrolyte panel tests in patients undergoing major orthopaedic surgery at a quaternary South African hospital

Moodley

Mashele

2021

The Journal of Medical Laboratory Science and Technology of Sou

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Background: Preoperative urea and electrolyte (U&E) panels are frequently requested for major surgery patients at risk for postoperative acute kidney injury (AKI). There is only one published study that has audited unnecessary preoperative U&E test panel utilisation in major surgery patients at a South African (SA) public sector hospital. This has significant implications for laboratory workloads, healthcare expenditure, and patient-friendly practice in the resource-limited SA public healthcare sector. Objective: To audit preoperative U&E panel requests in a sample of SA patients undergoing major orthopaedic surgery. Methods: We conducted a retrospective audit of adult primary hip arthroplasty patients who attended a quaternary SA hospital. Data on demographics, medical history, preoperative anaesthetic evaluations, operation details, and U&E panel requests were collected from each patient’s medical chart. The National Institute for Health and Care Excellence (NICE) guidelines, based on American Society of Anesthesiologists (ASA) grading and the presence of AKI risk factors, was used to distinguish between necessary and unnecessary preoperative U&E requests. We used descriptive statistics to analyse our study data. Results: Of the 175 patients comprising our study sample, 23 (13.1%) had preoperative U&E panels requested unnecessarily. All 23 patients were otherwise healthy and did not have any AKI risk factors. Conclusion: A small proportion of preoperative U&E test panels in our study sample of major orthopaedic surgery patients were deemed unnecessary. With that being said, there is still room for improvement in practices around preoperative U&E panel requests, which could be achieved through educational, computerised, and audit feedback interventions.

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“…One of the areas which has been scrutinised from time to time is the usefulness of routine pre-operative laboratory testing as a part of pre-operative assessment. [ 1 2 ] The task forces of the American Society of Anesthesiologists (ASA) and National Institute of Clinical and Health Excellence (NICE) have provided guidance on the use of pre-operative laboratory tests before elective surgeries for last one and half decades. [ 3 4 ] The current evidence and guidance recommend against the practice of routine pre-operative laboratory tests.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2018

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Background and Aims:One of the reasons for continued routine pre-operative testing practice is the identification of hidden problems which may affect perioperative management. This study was aimed to assess the prevalence of abnormal test results, their impact on perioperative management and cost-effectiveness for detecting such abnormalities.Methods:This observational study was conducted by screening the files of the patients attending pre-anaesthetic check-up during December 2016–January 2017. Patients' physical status, surgery grade, normal and abnormal test results and different impacts were noted and expressed in absolute numbers/percentage. Number needed to investigate (NNI) to detect a significant abnormality was calculated.Results:Data of 414 patients (46.3% male) with mean ± standard deviation age 43.78 ± 17.24 years and 58.65 ± 12.93 kg weight were analysed. Patients were mostly American Society of Anesthesiologists II and underwent National Institute of Clinical and Health Excellence Grade 3 surgeries. Totally, 345 (11.6%) test results were abnormal. Only 56 (16.2%) abnormalities had an impact in terms of referral, further investigations or delay. Twenty were significant in terms of changing perioperative anaesthetic management. Laboratory abnormalities with non-significant impact resulted in median delay of 3 days (range 1 to 12 days). The NNI for a significant impact and detecting new abnormality was 21 and 28, respectively.Conclusion:Majority (57.2%) of the patients had at least one abnormal routine test result but only 1.8% abnormalities had significant impact. The NNI to find a significant impact or hidden comorbidity was more than 20.

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Preoperative testing in elective surgery: Is it really cost effective?

Cited by 13 publications

References 11 publications

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

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

An audit of unnecessary preoperative urea and electrolyte panel tests in patients undergoing major orthopaedic surgery at a quaternary South African hospital

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

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