Abstract
Introduction: Prescription of routine complementary tests preoperatively has become a tradition for all practitioners. These tests are ordered frequently but their contribution doesn’t seem that significant. The aim of our study is to find out whether these systematic preoperative tests, prescribed for children undergoing elective minor and medium surgeries, were truly indicated or unjustified. Patients and Methods: We conducted a prospective, observational study including 230 children admitted for scheduled surgery with minor to medium bleeding risk. Several parameters were collected: the surgery and anesthesia characteristics, complementary preoperative tests, the tests prescriber, their usefulness and the cost of the prescription. Results: The mean age was 3 years old. The majority (95%) belonged to ASA I class. Twenty-eight percent of these children couldn’t walk yet. Eighty-two percent of the undergone surgeries had a minor bleeding risk. In 74% of cases, the chosen technique was a general anesthesia combined to local anesthesia. For the 230 patients studied, 857 complementary tests were requested. A systematic blood assessment was performed for all the patients. Only 35,86% of the realized tests were actually indicated. Excluding blood group, analysis of other tests showed that only 28,71% of them were abnormal. The total cost of the complementary tests was 8919.1 dinars of which 64,14% were spent on non-indicated tests. Conclusion: The systematic routine prescribing of blood tests must be forsaken to switch to a selective and rational prescription. Recommendations and guidelines may afford a precious help to organize the blood tests prescription procedure.
Highlights
Pre-operative evaluation is a fundamental for all patients proposed for a surgery
In 74% of cases, the chosen technique was a general anesthesia combined to local anesthesia
The total cost of the complementary tests was 8919.1 dinars of which 64,14% were spent on non-indicated tests
Summary
Pre-operative evaluation is a fundamental for all patients proposed for a surgery. It reduces per-operative risks (surgical or anesthetic) [1,2].This evaluation is based firstly on a good clinical investigation and the physical examination, on the complementary tests.The aims of these tests are essentially to obtain information about patients' aptitude for anesthesia and surgery, to detect unknown pathologies that may increase the operative risks and whose diagnosis may modify the pre and per-operative management [3].Various recommendations that tend to rationalize and limit this type of prescription are published in many countries. It reduces per-operative risks (surgical or anesthetic) [1,2] This evaluation is based firstly on a good clinical investigation and the physical examination, on the complementary tests. The aims of these tests are essentially to obtain information about patients' aptitude for anesthesia and surgery, to detect unknown pathologies that may increase the operative risks and whose diagnosis may modify the pre and per-operative management [3]. Because of the low incidence of associated cardiovascular and pulmonary diseases, the pediatric problem is dominated by the worry of detecting a disorder of hemostasis This kind of disorder may cause a bleeding complication associated to the anesthetic or the surgical technique
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