Utility of routine laboratory preoperative tests based on previous results: Time to give up.

Enrique Rodríguez–Borja,Arturo Carratala–Calvo,Gerardo Aguilar–Aguilar,Africa Corchon–Peyrallo

doi:10.11613/bm.2017.030902

Enrique Rodríguez–Borja, Arturo Carratala–Calvo + Show 2 more

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https://doi.org/10.11613/bm.2017.030902

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Abstract

IntroductionThe usefulness and cost-effectiveness of routine laboratory preoperative tests (POTs) have been challenged recently. In fact, the American Society of Anesthesiologists (ASA) Task Force has stated that test results obtained from the medical record within 6 months of surgery generally are mostly acceptable. The aim of our study was to evaluate the degree of utility of POTs and their clinical benefit based on this recommendation.Material and methodsWe studied retrospectively every routine POT request from 8 randomly selected weeks in 2016. Every POT contained glucose, creatinine, haemoglobin and coagulation tests (PT-INR). Each pathological result for these tests was registered and classified as “expected” (if previous pathological result within 6 months existed for that test) or “unexpected” (if previous pathological result within 6 months did not exist for that test). Results of ASA physical status classification (a system for assessing the fitness of patients before surgery) and changes in patient management after POTs were retrieved from medical history as well.ResultsA total of 4516 tests (from 1129 patients) were analysed and 498 results were found pathological (11%). Of these, 403 were expected (8.9%) and 95 unexpected (2.1%). There was not any change in anaesthetic management for any patient due to these findings.ConclusionsRoutine POTs are an inefficient and low-value service. POTs have to be always ordered selectively after a previous consideration of specific information obtained from several sources (medical records, interviews, examinations, type of surgery) and only if the information obtained will result in changes in the management of the patient.

Highlights

The usefulness and cost-effectiveness of routine laboratory preoperative tests (POTs) have been challenged recently
POTs have to be always ordered selectively after a previous consideration of specific information obtained from several sources and only if the information obtained will result in changes in the management of the patient
According to the Practice Advisory for Preanesthesia Evaluation by the American Society of Anesthesiologists (ASA) Task Force published in 2012, preanaesthesia evaluation consists of the consideration of information from several sources that may include patients medical records, but interview, physical examination and findings from medical tests and evaluations [1]

Summary

Introduction

The usefulness and cost-effectiveness of routine laboratory preoperative tests (POTs) have been challenged recently. Preoperative tests (POTs) are aimed at discovering a disorder and/or verifying an already known disease that may affect preoperative anaesthetic care These assessments may be used to formulate specific plans or alternatives for preoperative anaesthetic care and reduce morbidity associated with surgical-anaesthetic procedures [1]. The preoperative investigations include routine laboratory tests (metabolic panel, complete blood count, coagulation studies) done in the absence of any specific clinical indication or purpose. The appropriateness of this routine laboratory testing has been challenged in recent years.

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