Superfluous Amylase/lipase Testing at University-Affiliated Teaching Hospital: Retrospective Review: Presidential Poster Award

Abstract

Introduction: The combination of amylase and lipase in diagnosing acute pancreatitis is not better than lipase alone, however, both tests are commonly ordered simultaneously. Further, although there are no data to indicate usefulness of monitoring changes in elevated amylase and lipase levels, they are often ordered multiple times throughout the same single clinical encounter. The clinical utility of repeating amylase and lipase tests after an initially non-diagnostic result is not well studied. We explored the extent of superfluous amylase/lipase testing at the Boca Raton Regional hospital (BRRH), a university-affiliated teaching hospital in Florida. Methods: We retrospectively reviewed all amylase and lipase tests that were performed at the BRRH laboratory over a 6-month period. We considered amylase and lipase results diagnostic or borderline if they were ? or ≤ 3 x upper normal limits, respectively. During a single clinical encounter, we considered amylase tests superfluous if they were ordered simultaneously with lipase tests or repeated after diagnostic results, questionably superfluous if they were repeated alone, and non-superfluous otherwise, and lipase tests superfluous if they were repeated after diagnostic results, questionably superfluous if they were repeated after non-diagnostic results, and non-superfluous otherwise. Results: During up to 10 clinical encounters, 3502 patients had 8801 tests (4926 lipase, 3875 amylase), 4% of which were diagnostic and 10% borderline. Out of the 8801 tests, 45% were superfluous and 9% questionably superfluous. Non-superfluous testing was less frequent (p <0.0001) in the intensive care/step down units (22% of 748 tests) than emergency department (54% of 6000 tests) or other settings (31% of 2053 tests). Among 3545 simultaneous amylase/lipase tests with non-diagnostic lipase results, 0.6% of amylase results were diagnostic. Of the 190 lipase tests repeated after non-diagnostic lipase results, 13% were diagnostic. Conclusion: Superfluous amylase/lipase testing in one teaching hospital is substantial; there is large room for reducing healthcare cost without compromising quality of care when evaluating patient for pancreatitis.