Abstract
Background: Previous studies stressed on the burden raised by routine pre-operative test ordering, which should be based on the assessment of patient physical status. In a tertiary hospital in Jordan, we aim to study the compliance with guidelines regarding pre-operative routine testing prior to an elective surgery, cholecystectomy, and calculate the estimated cost from non-compliance with the guidelines.Methods: We included laparoscopic cholecystectomy (through ICD-9 code) to represent an elective surgery. For each surgery done from the period 1/1/2016 to 31/12/2016, data regarding preoperative investigations, admission history note, operative and discharge note were obtained. Tests that are considered routine investigations are Complete blood count (CBC), kidney function tests (KFT), electrolytes, chest X-ray, electrocardiogram, coagulation studies, and urine-analysis. We classified patients who underwent cholecystectomy according to the latest version of the American Society of Anesthesiologists (ASA) physical status system to assess the need for routine tests, then we calculated the number and cost of excess tests.Results: A total 382 routine, non-emergent laparoscopic cholecystectomy surgeries were performed. 319 (83.5%) of patients were classified as ASA-1, 60 (15.7%) were classified as ASA-2, and only 3 (0.8%) were classified as ASA-3. Age was a significant determinant in obtaining chest X-ray ordering and findings (p< 0.001) and electrolytes ordering and findings (p= 0.001). Total routine tests cost for elective cholecystectomy during 2016 was 16,021$. Regarding operative compilations, only 14 (3.7%) complication occurred, all of which were bleeding related.Conclusion: Oversighting routine preoperative test ordering before elective cholecystectomy will significantly reduce the cost without increasing post-operative complications.
Highlights
Routine tests are those tests ordered in the absence of a specific clinical indication or purpose (ASA, 2012), an example of routine tests are those ordered preoperatively for screening purposes without clinical indication
Two main guidelines globally accepted to define the indications of preoperative routine tests before elective surgeries; the practice advisory for pre-anesthesia evaluation developed by American Society of Anesthesiologists (ASA) (ASA, 2012), and the National Institute for Health and Care Excellence (NICE) guidelines (NICE, 2016)
Tests that are considered routine investigations are: - Complete blood count (CBC) - Kidney function tests (KFT) - Electrolytes - Chest X-ray - Electrocardiogram - Coagulation studies - Urine-analysis We assessed if chest X-ray was ordered along with its result if abnormal findings were detected or not, abnormal findings on chest X-ray were determined based on the radiological reports written by radiologists
Summary
Routine tests are those tests ordered in the absence of a specific clinical indication or purpose (ASA, 2012), an example of routine tests are those ordered preoperatively for screening purposes without clinical indication. Previous studies stressed on the burden raised by routine pre-operative test ordering, which should be based on the assessment of patient physical status. In a tertiary hospital in Jordan, we aim to study the compliance with guidelines regarding pre-operative routine testing prior to an elective surgery, cholecystectomy, and calculate the estimated cost from non-compliance with the guidelines. We classified patients who underwent cholecystectomy according to the latest version of the American Society of Anesthesiologists (ASA) physical status system to assess the need for routine tests, we calculated the number and cost of excess tests. Age was a significant determinant in obtaining chest X-ray ordering www.scholink.org/ojs/index.php/rhs
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
