Validity time of normal results of preoperative tests for surgical reintervention and the impact on postoperative outcomes

Ramos, Lafayete; Souza, Cristiano Freitas de; Dias, Ivan Wilson Hossni; Oliveira, R. G. de; Bárbara, Cristina; Calil, Marcelo; Góes, João Carlos Sampaio

doi:10.1016/j.bjane.2017.10.005

Cited by 6 publications

(5 citation statements)

References 23 publications

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“…Although there is no clear consensus on what the validity period of a PCXR, CW and "Essencial" is, it is set at 6 months for patients older than 70 years [16,19]; The Royal College of Radiologists, in a guideline from 1994, extended it up to 12 months in smokers or patients with cardiorespiratory disease [39]. This period of validity for PCXRs would be consistent with the results obtained in a study carried out in 2017 in Brazil, which concluded that the probability of finding changes in the year after a normal result in a preoperative test would be only 1.7% [40]. On the other hand, the results of our study for CW and "Essencial" are congruent with those of another study performed in Austria in 2007, in which it was found that up to 80% of duplicate PCXRs could be unnecessary [38].…”

Section: Discussionmentioning

confidence: 54%

Estimation of the Overuse of Preoperative Chest X-rays According to “Choosing Wisely”, “No Hacer”, and “Essencial” Initiatives: Are They Equally Applicable and Comparable?

Vicente-Guijarro

Valencia-Martín

Moreno-Nunez

et al. 2020

IJERPH

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Background: Overuse reduces the efficiency of healthcare systems and compromises patient safety. Different institutions have issued recommendations on the indication of preoperative chest X-rays, but the degree of compliance with these recommendations is unknown. This study investigates the frequency and characteristics of the inappropriateness of this practice. Methods: This is a descriptive observational study with analytical components, performed in a tertiary hospital in the Community of Madrid (Spain) between July 2018 and June 2019. The inappropriateness of preoperative chest X-ray tests was analyzed according to “Choosing Wisely”, “No Hacer” and “Essencial” initiatives and the cost associated with this practice was estimated in Relative Value and Monetary Units. Results: A total of 3449 preoperative chest X-ray tests were performed during the period of study. In total, 5.4% of them were unjustified according to the “No Hacer” recommendation and 73.3% according to “Choosing Wisely” and “Essencial” criteria, which would be equivalent to 5.6% and 11.8% of the interventions in which this test was unnecessary, respectively. One or more preoperative chest X-ray(s) were indicated in more than 20% of the interventions in which another chest X-ray had already been performed in the previous 3 months. A higher inappropriateness score was also recorded for interventions with an American Society of Anesthesiologists (ASA) grade ≥ III (16.5%). The Anesthesiology service obtained a lower inappropriateness score than other Petitioning Surgical Services (57.5% according to “Choosing Wisely” and “Essencial”; 4.1% according to “No Hacer”). Inappropriate indication of chest X-rays represents an annual cost of EUR 52,122.69 (170.1 Relative Value Units) according to “No Hacer” and EUR 3895.29 (2276.1 Relative Value Units) according to “Choosing Wisely” or “Essencial” criteria. Conclusions: There was wide variability between the recommendations that directly affected the degree of inappropriateness found, with the main reasons for inappropriateness being duplication of preoperative chest X-rays and the lack of consideration of the particularities of thoracic interventions. This inappropriateness implies a significant expense according to the applicable recommendations and therefore a high opportunity cost.

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Section: Discussionmentioning

confidence: 54%

Estimation of the Overuse of Preoperative Chest X-rays According to “Choosing Wisely”, “No Hacer”, and “Essencial” Initiatives: Are They Equally Applicable and Comparable?

Vicente-Guijarro

Valencia-Martín

Moreno-Nunez

et al. 2020

IJERPH

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“…In a study of 970 patients, the probability of a change in previously normal preoperative tests was found to be only 1.7% (confidence interval [CI] 0.5–2.9) at 12 months in patients <50 years and 2.1% (CI 0.7–3.5) in those ≥50 years. 36 …”

Section: Discussionmentioning

confidence: 99%

“…Moreover, the likelihood for changes in test results was associated with increasing age ( p = 0.009), higher surgical risk ( p < 0.001), chemotherapy ( p = 0.001), radiotherapy ( p = 0.012), and comorbidities ( p < 0.001). 36 This suggests that the validity of normal preoperative tests could potentially be extended beyond 4 weeks without compromising patient safety. Accordingly, the institution's preoperative testing guidelines should be revised, with validity extended beyond 4 weeks.…”

Section: Discussionmentioning

confidence: 99%

Perceptions and Attitudes of Patients and Health Care Stakeholders on Implementing a Telehealth Service for Preoperative Evaluation: A Qualitative Analysis

Lew

Tan

Teo

et al. 2023

Telemedicine Reports

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Background: Studies suggest that preoperative evaluation can be effectively conducted through telehealth. As the COVID-19 pandemic has accelerated digital transformation, we hypothesize that a new telehealth model of care may be feasibly implemented for preoperative evaluation at our institution. This qualitative study seeks to evaluate the attitudes and perception of elective surgery patients and health care providers toward telehealth conducted for preanesthesia evaluation. Methods: At a tertiary women's hospital in Asia, health care providers and elective surgery patients were recruited by convenience and snowball sampling to undergo one-on-one semistructured interviews regarding a new telehealth model of care for preanesthesia evaluation, under-pinned by the Normalization Process Theory. Data were analyzed, coded, and consolidated into themes using the framework analysis method by a team of four researchers from diverse backgrounds. Results: Twenty-five interviews were conducted among 10 patients and 15 health care participants. Ninety-five codes were identified, consolidated into four themes that connect to guide the implementation of a new telehealth pathway for preoperative care, mapped to the Normalization Process Theory. The themes pertain to advantages of telehealth workflow (coherence), requisites for new telehealth workflow (coherence, collective action), barriers to implementation (cognitive participation, collective action), and enablers of implementation (cognitive participation, collective action). All participants were receptive to telehealth, but health care participants expressed concern about the impact of additional tasks on current clinical workload. Training in videoconferencing was deemed essential by both patients and health care providers. Conclusions: The study has provided insights into levels of coherence and cognitive participation among patients and health care providers. The telehealth workflow should be redesigned, considering systems' constraints and stakeholders' needs. Greater buy-in is needed to gain health care providers' commitment for collective action. identifier: NCT05781789

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“…One study (n = 235010) concluded that normal blood test reports (CBC, LFT, RFT, serum sodium, and coagulation profile (PT/INR, aPTT) obtained within the last 2 months from the date of surgery did not differ significantly in their influence on the outcomes studied compared to those which were performed within 1 or 2 weeks prior to surgery. [ 71 ] A retrospective cohort study (n = 932)[ 72 ] considered the preoperative test reports (CBC, blood glucose, RFT, coagulation tests, ECG and chest x-ray) obtained for the first surgical procedure and compared with the test reports obtained for re-interventions (6-84 months interval). The preoperative test reports obtained for second surgery performed 12 months after the first intervention, remained largely unaltered and minor alterations did not have any influence on the outcomes.…”

Section: Guidelines and Recommendationsmentioning

confidence: 99%

Preoperative Investigations: Practice Guidelines from the Indian Society of Anaesthesiologists

Umesh¹,

Bhaskar²,

Harsoor³

et al. 2022

Indian J Anaesth

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Validity time of normal results of preoperative tests for surgical reintervention and the impact on postoperative outcomes

Cited by 6 publications

References 23 publications

Estimation of the Overuse of Preoperative Chest X-rays According to “Choosing Wisely”, “No Hacer”, and “Essencial” Initiatives: Are They Equally Applicable and Comparable?

Estimation of the Overuse of Preoperative Chest X-rays According to “Choosing Wisely”, “No Hacer”, and “Essencial” Initiatives: Are They Equally Applicable and Comparable?

Perceptions and Attitudes of Patients and Health Care Stakeholders on Implementing a Telehealth Service for Preoperative Evaluation: A Qualitative Analysis

Preoperative Investigations: Practice Guidelines from the Indian Society of Anaesthesiologists

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