Utility of routine laboratory preoperative tests based on previous results: Time to give up

Abstract

IntroductionThe usefulness and cost-effectiveness of routine laboratory preoperative tests (POTs) have been challenged recently. In fact, the American Society of Anesthesiologists (ASA) Task Force has stated that test results obtained from the medical record within 6 months of surgery generally are mostly acceptable. The aim of our study was to evaluate the degree of utility of POTs and their clinical benefit based on this recommendation.Material and methodsWe studied retrospectively every routine POT request from 8 randomly selected weeks in 2016. Every POT contained glucose, creatinine, haemoglobin and coagulation tests (PT-INR). Each pathological result for these tests was registered and classified as “expected” (if previous pathological result within 6 months existed for that test) or “unexpected” (if previous pathological result within 6 months did not exist for that test). Results of ASA physical status classification (a system for assessing the fitness of patients before surgery) and changes in patient management after POTs were retrieved from medical history as well.ResultsA total of 4516 tests (from 1129 patients) were analysed and 498 results were found pathological (11%). Of these, 403 were expected (8.9%) and 95 unexpected (2.1%). There was not any change in anaesthetic management for any patient due to these findings.ConclusionsRoutine POTs are an inefficient and low-value service. POTs have to be always ordered selectively after a previous consideration of specific information obtained from several sources (medical records, interviews, examinations, type of surgery) and only if the information obtained will result in changes in the management of the patient.

Hypoalbuminemia and Elevated CRP are Risk Factors for Deep Infections and Urinary Tract Infections After Lumbar Spine Surgery in a Large Retrospective Patient Population

“…Additionally, routine pre-operative laboratory work up has been demonstrated to be a significant cost saving measure in septoplasty, though no literature currently exists within the orthopedic spine surgery space. 48 However, one study by Rodriguez et al 49 have noted that routine pre-operative tests are redundant, as lab results of patients who were indicated to undergo pre-operative laboratory tests per guideline recommendations 50 did not yield unexpected results and consequently did not change anesthetic management. In another study by Onuoha et al , 51 70% of routine pre-operative metabolic panels, a commonly used blood test in the United States that measures serum electrolytes, kidney function, and glucose levels, were collected in patients who were sufficiently healthy according the American Society of Anesthesiology physical status.…”

Information technology-based joint preoperative assessment, risk stratification and its impact on patient management, perioperative outcome, and cost

“…The cost-effectiveness of routine testing is questioned by developing countries too 10 .In our study, the investigation was rationalised using a patient and surgery specific investigation protocol. Even the majority (80.9%) of the abnormal test results found in routine preoperative tests are predictable from patients' clinical condition 11 . Notably, most abnormal test results in routine preoperative tests do not change anaesthesia management 1 11-13 , even in oncological and older patients 14,15 .…”

“…Even the majority (80.9%) of the abnormal test results found in routine preoperative tests are predictable from patients' clinical condition 11 . Notably, most abnormal test results in routine preoperative tests do not change anaesthesia management 1 11-13 , even in oncological and older patients 14,15 . However, laboratory tests specific to the patient’s comorbid condition has an impact in changing the anaesthesia management 16 .…”

Conceptos básicos para la solicitud e interpretación de analíticas en Podología.

“…Sabemos que la solicitud indiscriminada de pruebas, en este caso de laboratorio, genera tanto gastos como riesgos innecesarios a los pacientes 79 . Es un hecho que cuantas más pruebas y parámetros solicitemos, mayor probabilidad de encontrar resultados falsos positivos habrá 80 , lo cual genera estados de ansiedad a los pacientes, y a su vez genera la necesidad de más pruebas para confirmar o descartar ese "positivo". Debe quedar claro, por tanto, que las pruebas complementarias en general, y las de laboratorio en particular, no deben convertirse en solicitudes "rutinarias" sino que siempre han de ir encaminadas a aclarar una sospecha clínica razonable o para comprobar si, en base a los resultados obtenidos, hemos de modificar nuestra actitud terapéutica, por ejemplo ante una intervención quirúrgica.…”