BS O05 Should we be doing routine post-operative blood tests in patients undergoing elective bariatric surgery?

Abstract

Abstract Background Bariatric and metabolic surgery (BMS) has a low complication and readmission rate; complications however, when they do occur, can be major and life-threatening. Routine post-operative blood testing (POBT) is commonplace following BMS to assess for complications but has resource implications. We aimed to assess whether POBT in our unit predicted complication or readmission rates. We found no existing studies evaluating the efficacy of routine POBT in the bariatric surgery cohort. Methods All patients undergoing BMS between July ’20 – June ’21 were retrospectively identified from our local database. Data gathered were: Patient demographics; operation, POBT (FBC, U&E, CRP); length of stay; 30-day complications and 30-day readmissions. Financial cost of POBT were also calculated. Descriptive statistics and Fishers exact test were used to analyse results. Results 149 patients were identified (OAGB - 81, RYGB - 32, LSG - 36); all had POBT. 115 patients (77%) were discharged on the expected post-operative day (median LOS - 1 days). 38 patients (25.5%) had abnormal POBT results according to defined parameters laid out in our protocol. Abnormal POBT resulted in a change to management plan in 8 patients (5.4%), with subsequent increased LOS for further investigation or observation; in all of these cases there were signs of deterioration via observations and/or clinical symptoms. 8 (5.4%) patients were readmitted in 30-days, 3 of whom had abnormal POBT following their surgery. There was no statistical correlation between abnormal POBT and 30-day readmission rate, p=0.42. POBT in the cohort total cost was in the region of £2400. Conclusions In this study we observed that POBT did not predict adverse outcome without clinical signs of deterioration. A considerable number of POBT are performed routinely without clinical indication. A patient-specific approach is recommended based on intra-operative and post-operative clinical assessment rather than routine usage, resulting in cost savings to the Trust and better patient flow with safe and efficient discharges. It is also important to consider the financial impact of performing routine POBT in all patients undergoing BMS; due to both the costs of POBT, staff hours as well as the potential costs due to delayed discharges.