EP.TH.1025The necessity of pre-operative investigations for elective surgical patients

Abstract

Abstract Introduction Patients admitted for elective surgeries tend to get quite a few investigations at pre assessment. Are these strictly necessary? Are there significant cost implications? National Institute for health and Care Excellence first issued guidance on routine preoperative tests for elective surgery in 2003. Aims To carry out an audit of pre-operative investigations of elective surgical patients at pre-admission. To determine level of unnecessary tests. Results Regarding correlation between ASA grades and over testing, grade 4 is the highest and grade 2 is the lowest in meeting standard guideline per ASA grade. Only 20% intermediate surgical cases meet the guideline whereas 30% of minor and 85% of major cases meet guideline per surgery grade respectively. Majority of unnecessary tests are carried out in minor and intermediate cases. Very few cases of missing tests. Only four tests that should have been taken as per the guideline weren’t done in the whole cohort. For all cases,57.4% of FBC,38.2% of U&Es, 48.5% ECG and 5.9% lung function tests carried out unnecessarily. Conclusion Generally we are over-testing patients at pre-assessment. This seems to be an issue with minor and intermediate cases, with majors generally doing better in fulfilling the guidelines. This may not be deliberate but coincidence as major surgeries call for more tests. Over-testing is more of an issue in lower (1-2) ASA grades in minor and intermediate surgeries. Under-testing is very rare. Using NICE’s estimated costs for each test, approximately £965.78 was spent in 1.5 months for tests which were not needed.