Impact of using a local protocol in preoperative testing: blind randomized clinical trial.

Mônica Loureiro Santos,Antônio Carlos Iglesias

doi:10.1590/0100-69912017001015

Abstract

to evaluate the impact of the use of a local protocol of preoperative test requests in reducing the number of exams requested and in the occurrence of changes in surgical anesthetic management and perioperative complications. we conducted a randomized, blinded clinical trial at the Gaffrée and Guinle University Hospital with 405 patients candidates for elective surgery randomly divided into two groups, according to the practice of requesting preoperative exams: a group with non-selectively requested exams and a protocol group with exams requested according to the study protocol. Studied exams: complete blood count, coagulogram, glycemia, electrolytes, urea and creatinine, ECG and chest X-ray. Primary outcomes: changes in surgical anesthetic management caused by abnormal exams, reduction of the number of exams requested after the use of the protocol and perioperative complications. there was a significant difference (p<0.001) in the number of exams with altered results between the two groups (14.9% vs. 29.1%) and a reduction of 57.3% in the number of exams requested between the two groups (p<0.001), which was more pronounced in patients of lower age groups, ASA I, without associated diseases and submitted to smaller procedures. There was no significant difference in the frequency of conduct changes motivated by the results of exams or complications between the two groups. In the multivariate analysis, complete blood count and coagulogram were the only exams capable of modifying the anesthetic-surgical management. the proposed protocol was effective in eliminating a significant number of complementary exams without clinical indication, without an increase in perioperative morbidity and mortality.

Highlights

The preoperative evaluation (POE) seeks to promote safety in surgery and anesthesia, to ensure a better quality of care, as well as the rational use of resources in the perioperative period
There were 1428 preoperative complementary exams (POCE) in the RG and 601 exams in the Protocol Group (PG), of which 14.9% and 29.1% were altered in the Routine Group (n=204) n (%)
Several studies seek to analyze the effectiveness of preoperative examinations in modifying surgical anesthetic management and its impact on the frequency of perioperative complications

Summary

Introduction

The preoperative evaluation (POE) seeks to promote safety in surgery and anesthesia, to ensure a better quality of care, as well as the rational use of resources in the perioperative period. History and physical examination should be considered the main components of the POE, with the complementary exams remaining under specific clinical conditions[1,2,3]. Patients who are candidates for elective operations have requested preoperative complementary exams (POCE) routinely and indifferently to the clinical findings of the POE. This is based on several factors, such as: ability to identify diseases not diagnosed by anamnesis and physical examination, safety assurance to the professionals involved in the process to make decisions regarding the resolution of intercurrences, as well as safeguarding possible legal responsibilities[4]. There is a risk that non-clinically based tests, especially on the occurrence of false positives, may lead to further invasive investigations, leading to postponement of operations as well as inadequate treatment[3,5]

Objectives

Methods

Results

Conclusion