Preoperative testing is inconsistent with published guidelines and rarely changes management

Bryson, Gregory L.; Wyand, Anna; Bragg, Paul

doi:10.1007/bf03022208

Cited by 130 publications

(82 citation statements)

References 3 publications

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“…x-ray, CT scan …) [1]. The extend of using of any data resources depends on patients clinical condition, the type of surgery and anesthesiology and surgery team training level in prediction and prevention of complication and must use available, low risk and cheap but effective sources [1]- [3]. Although, the best ways of evaluation and obtaining information before surgery are exact history and physical examination [1] [4], some simple tests for clinical findings confirmation, severity of pathologic cases help to unknown problems [5].…”

Section: Introductionmentioning

confidence: 99%

The Association between Preoperative Plasma C-Reactive Protein (CRP) Level and Postoperative Adult Heart Surgery Outcome

Bilehjani¹,

Fakhari²,

Farzin³

et al. 2016

OJIM

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Introduction: Careful history and physical examinations are the best ways for preoperative evaluation. Currently, we are recommended to rely on doing them rather than unnecessary and costly laboratory tests for confirmation or diagnosis of disease. The aim of study is the survey of CRP level association to decide further evaluation and expert consultation, newly diagnosed problems and possible effect on postoperative mortality and morbidity. Methods and Materials: In a descriptive retrospective study, hospital documentation of 620 patients older than 18 years undergone heart surgery in Tabriz Shahid Madani hospital was evaluated. Addition to plasma CRP level, patient's demographic information, type of surgery, preoperative significant tests, delay time in surgery start time after anesthesiology visit, cause of requested specialty consultation and treatment recommendation, postoperative complications and mortality rate were recorded and analyzed. Patients were classified according to preoperative plasma CRP level to five groups as negative, +1, +2, +3 and not measured (i.e. they considered as normal (0 -5 mg/l), mildly (5 -40 mg/l), moderately (40 -200 mg/L) or severely increased (>200 mg/l) groups). Results: Of 620 patients, 402 were male and 218 were female. There was not statistically significant correlation among demographic variables (gender, age, weight, and height), heart disease diagnosis and the type of surgery in five groups. In 79 individuals, they were done specialty consultations that most common of them were neurology consultation because of impaired renal laboratory tests. Only 2 cases were due to high CRP level. In any of cases, this preoperative consultation didn't result from new disease cases. CRP plasma level hadn't association with preoperative red blood cell sedimentation level. Prevalence of preoperative acute myocardium infarction was higher in * Corresponding author. B. Eissa et al. 94patients with high CRP level. In group +1, delay time was lower than other groups. The most common causes were cardiac causes. There wasn't statistically significant correlation between CRP level and different postoperative complications. There wasn't significant association between ICU stay time and postoperative hospital stay time and plasma high CRP level. Conclusion: Probably, plasma CRP level increases before surgery in acute myocardial infarction and results in high mortality rate. It seems that routine measurement of CRP in candidates for heart operation is beneficial for mortality rate prediction, so its increasing level can't help to diagnosis newly cases and it isn't prudent to consult with specialist.

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Section: Introductionmentioning

confidence: 99%

The Association between Preoperative Plasma C-Reactive Protein (CRP) Level and Postoperative Adult Heart Surgery Outcome

Bilehjani¹,

Fakhari²,

Farzin³

et al. 2016

OJIM

View full text Add to dashboard Cite

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“…To assess the risk of perioperative bleeding prior to surgery or other invasive procedures, laboratory screening tests (usually PT, aPTT, and platelet count) are still widely used, although indiscriminate coagulation screening in unselected patients is not recommended. 5,6,29,30 Guidelines on preoperative assessment highlight the role of an accurate bleeding history, including details of personal and family history, previous post-traumatic or post-surgical hemorrhage and use of anti-thrombotic drugs. As no questionnaire on bleeding diathesis has been validated for the preoperative period, many anesthesiologists and other physicians still prescribe nonspecific coagulation tests (PT, aPTT, platelet count) for reassurance.…”

Section: Discussionmentioning

confidence: 99%

Preoperative hemostatic assessment: a new and simple bleeding questionnaire

Bonhomme

Boehlen²,

Clergue

et al. 2016

Can J Anesth/J Can Anesth

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Purpose Current recommendations for the assessment of the risk of perioperative bleeding limit coagulation testing to patients with a personal and/or family history of bleeding. As no simple preoperative screening questionnaire is currently available, we assessed the performance of a novel screening questionnaire for its ability to detect bleeding disorders. Methods A dichotomized, seven-point questionnaire named HEMSTOP (Hematoma, hEmorrhage, Menorrhagia, Surgery, Tooth extraction, Obstetrics, Parents) was applied to three groups of subjects: patients referred to hemostasis specialists for bleeding symptoms for whom any kind of perioperative hemostatic precautions were subsequently recommended (n = 38); patients referred to hemostasis specialists for whom precautions were not required (n = 75); healthy volunteers (n = 70). We calculated the sensitivity and specificity of HEMSTOP scores and compared them with the discriminative performances of standard blood coagulation assays (prothrombin time, activated partial thromboplastin time

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“…[3,4] Further, this testing seldom changes management. [5] Despite recommendations from the ASA, the American College of Cardiology and the American Board of Internal Medicine Foundation (Choose Wisely Campaign TM ), patients are still routinely sent for preoperative "clearance" by primary care providers, internists and preoperative clinics like ours. In an environment of shrinking reimbursement and bundled payments, avoiding unnecessary preoperative testing and clinic visits makes economic sense.…”

Section: Discussionmentioning

confidence: 99%

Identification of appropriate patients for preoperative evaluation: A quality improvement project

Trentman

Graber

Goss

et al. 2016

JHA

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Objective: Appropriate preoperative evaluation is essential for safe surgical care. Cost containment and "best practice" suggest that preoperative testing should be matched to patient co-morbidities and the magnitude of the planned procedure. The purpose of this project was to reduce the number of unnecessary referrals to our preoperative evaluation clinic (POE), increase clinic capacity for medically complex patients including diabetics, and quantify the reduction in institutional cost associated with the project. Methods: In addition to other educational activities, a simplified algorithm and optional screening tool were created to assist surgeons with determining which patients should go to POE. A sub-group of pilot surgeons were selected to participate and their POE referral performance was tracked and shared with them. Surgeons were encouraged to send all of their diabetic patients through POE. A cost analysis was carried out to quantify changes in institutional average cost per case for preoperative evaluation, before vs. after project launch. The first quarter of 2013 (pre-project launch) was compared to first quarter 2015. Results: Pilot surgeons reduced referrals to POE by 30%, while decreasing the institutional average cost per case of preoperative evaluation by > 50%. Clinic capacity for complex patients increased, although diabetic referrals remained flat during the project. There was no increase in day of surgery cancellations. Conclusions: This project demonstrates that patterns of preoperative evaluation for healthy patients undergoing low-acuity surgery can be changed, bringing about cost savings, without increasing day of surgery cancellations.

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Preoperative testing is inconsistent with published guidelines and rarely changes management

Abstract: The majority of elective surgical patients undergo preoperative testing. Non-compliance with guidelines ranged from 5 to 98%. The results of most tests were normal and influenced management in only 2.6% of cases.

Cited by 130 publications

References 3 publications

The Association between Preoperative Plasma C-Reactive Protein (CRP) Level and Postoperative Adult Heart Surgery Outcome

The Association between Preoperative Plasma C-Reactive Protein (CRP) Level and Postoperative Adult Heart Surgery Outcome

Preoperative hemostatic assessment: a new and simple bleeding questionnaire

Identification of appropriate patients for preoperative evaluation: A quality improvement project

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