Superfluous amylase/lipase testing at a tertiary care hospital: a retrospective study

Abstract

BACKGROUND: Measuring both serum amylase and lipase in the setting of acute pancreatitis is not recommended and monitoring changes in amylase and lipase levels after diagnostic results is of little added value. The extent of the two types of superfluous amylase/lipase testing at our institution is unknown.OBJECTIVE: Explore the extent of superfluous amylase/lipase testing.DESIGN: Medical record review.SETTINGS: Tertiary care, teaching hospital.PATIENTS AND METHODS: We retrospectively reviewed all amylase and lipase tests performed over a recent 12-month period. Amylase tests were considered superfluous if they were ordered with lipase tests at the same time or if they were repeated after diagnostic amylase results. They were considered questionably superfluous if they were repeated alone after non-diagnostic amylase results. Lipase tests were considered superfluous if they were repeated after diagnostic lipase results and questionably superfluous if they were repeated after non-diagnostic lipase results.MAIN OUTCOME MEASURES: Number and percentage of lipase and amylase tests that were superfluous or questionably superfluous.SAMPLE SIZE: 23 950.RESULTS: Superfluous testing was identified in 30.6% of 23 950 amylase/lipase tests and questionably superfluous testing in 12.4%. Of the 7330 superfluous tests, 94.8% were due to simultaneous amylase/lipase testing and 5.2% to repeated lipase testing after diagnostic results. The rate of superfluous and questionably superfluous testing was significantly higher in the inpatient setting compared to emergency department or outpatient settings (P<.0001). Of the 6483 amylase tests obtained simultaneously with non-diagnostic lipase tests, only 36 (0.6%) showed a diagnostic result. Furthermore, only 0.7% and 3.6% of amylase tests that were repeated after normal and borderline results, respectively, were diagnostic and 1.1% and 9.3% of lipase tests that were repeated after normal and borderline results, respectively, were diagnostic.CONCLUSIONS: About one third of amylase/lipase testing appears to be superfluous, mainly due to simultaneous amylase/lipase testing. Since only 0.6% of simultaneous amylase/lipase tests showed diagnostic amylase with non-diagnostic lipase levels, quality improvement initiatives should be directed at reducing this low-value practice. Repeating amylase/lipase tests following normal results is of little value.LIMITATIONS: Clinical notes and imaging studies were not reviewed.CONFLICT OF INTEREST: None.

Factors Associated With Serial Lipase Measurement in Hospitalized Patients With Acute Pancreatitis

“…Although studies have failed to demonstrate the prognostic value of repeat lipase measurement after the initial diagnosis of AP, 26 they are often obtained multiple times throughout the course of a single AP episode. 15,27 Consistent with prior studies, 15,27 our study showed that more than one-third of inpatients with AP had repeat lipase measurements after an initial lipase value that was diagnostic for AP. There is one clinical scenario in which serial lipase measurement may be warranted: if the initial presentation is within 4 to 5 hours of abdominal pain onset and lipase level is normal, but suspicion for AP is high.…”

“…Although studies have failed to demonstrate the prognostic value of repeat lipase measurement after the initial diagnosis of AP, 26 they are often obtained multiple times throughout the course of a single AP episode 15,27 . Consistent with prior studies, 15,27 our study showed that more than one-third of inpatients with AP had repeat lipase measurements after an initial lipase value that was diagnostic for AP.…”

The Prevalence of Simultaneously Ordering Amylase and Lipase for Diagnosing Pancreatitis

“…Consequently, only 3.6% of the tests were diagnostic for acute pancreatitis [21]. Tis is in accordance with many investigations that have found that simultaneous requests for both serum amylase and lipase are unnecessary, since serum lipase alone has displayed better sensitivity and specifcity compared to serum amylase [7,8,[18][19][20][21][22]. Serum lipase has been demonstrated to have a higher diagnostic sensitivity than serum amylase [23].…”

“…In our study, 7.8% of serum amylase tests were repeated, and 3.3% were requested for serum amylase alone, which was lower than the rate of 12.4% reported in other studies. Consequently, only 3.6% of the tests were diagnostic for acute pancreatitis [ 21 ]. This is in accordance with many investigations that have found that simultaneous requests for both serum amylase and lipase are unnecessary, since serum lipase alone has displayed better sensitivity and specificity compared to serum amylase [ 7 , 8 , 18 – 22 ].…”

Utility of Serum Amylase in Children With Abdominal Pain in the Pediatric Emergency Department

“…Our findings indicate that the combination of serum amylase and lipase is not a superior testing modality than serum lipase alone. Although our study did not evaluate symptomatology, we support the recommendations of using serum lipase in specific instances, 5,10,15,21 thus decreasing serum amylase use by at least 85% without compromising patient care. 1,22 This will lead to financial savings, minimal loss of clinically useful information, and a reduction in health care waste and resources.…”