Preoperative Laboratory Testing

Böck, Matthias; Fritsch, Gerhard; Hepner, David L.

doi:10.1016/j.anclin.2015.10.005

Cited by 30 publications

(29 citation statements)

References 80 publications

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“…8 Studies indicate that many routinely ordered preoperative laboratory tests are of limited clinical utility, and that preoperative laboratory assessment should be individualized to the patient and the surgery rather than routine. [9][10][11] Similar consideration of routine postoperative laboratory values has been undertaken in many surgical disciplines, including gynecology and orthopedic surgery. [12][13][14] The Society of Hospital Medicine partnered with the American Board of Internal Medicine Foundation to provide recommendations through their Choosing Wisely initiative to help clinicians address overuse of medical tests, which include the recommendations 1) to avoid transfusions of red blood cells for arbitrary hemoglobin thresholds in the absence of symptoms and 2) not to perform repetitive complete blood count and chemistry testing in the face of clinical and laboratory stability.…”

Section: Discussionmentioning

confidence: 99%

Routine Postoperative Hemoglobin Assessment Poorly Predicts Transfusion Requirement among Patients Undergoing Minimally Invasive Radical Prostatectomy

et al. 2020

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Introduction: An advantage of minimally invasive radical prostatectomy over open surgery is decreased blood loss. At our institution hemoglobin is routinely checked 4 and 14 hours postoperatively. We assessed the relevance of this practice in a contemporary cohort undergoing minimally invasive radical prostatectomy. Methods: We retrospectively reviewed data from patients undergoing laparoscopic or robotic radical prostatectomy at our institution between January 2010 and September 2018. We identified 3,631 patients with preoperative and postoperative hemoglobin values, and assessed the role of routine hemoglobin assessment in determining need for transfusion within 30 days. Medicare reimbursement rates for 2019 were used for cost analysis. Results: Of 3,631 patients in our cohort 44 (1.2%) required transfusion. At 4 hours following surgery the median hemoglobin decrease was 8.0% (IQR 4.8 to 11.4) for patients who did not receive transfusion and 12.5% (9.5 to 19.2) for those who received transfusion. At 14 hours the median decrease was 14.2% (IQR 10.0 to 18.4) vs 33.1% (22.6 to 38.6). Routine hemoglobin assessment had no role in the decision to transfuse in 18 patients (41%). No patient was transfused based on 4-hour values alone. Omitting 1 hemoglobin assessment could have resulted in institutional savings of $37,000 during this period.

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Section: Discussionmentioning

confidence: 99%

Routine Postoperative Hemoglobin Assessment Poorly Predicts Transfusion Requirement among Patients Undergoing Minimally Invasive Radical Prostatectomy

et al. 2020

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“…A history of anaemia is an indication for obtaining an haemoglobin prior to low-risk procedures. In intermediate and high-risk procedures, with potential for significant blood loss, obtaining a baseline haemoglobin is recommended (Bock et al 2016, Kaplan et al 1985). Routine coagulation studies or platelet counts are not predictive of perioperative bleeding.…”

Section: Discussionmentioning

confidence: 99%

Rationale and design of an evidence-based tool to guide preoperative evaluation and management

Campbell

Ingham

Shepherd

et al. 2020

Journal of Perioperative Practice

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Background In the United States, over-testing and over-treatment are recognised causes of excess cost and patient harm. Healthcare value, defined as health outcomes achieved relative to the costs of care, has become a focus to improve the quality and affordability of healthcare. Aim To describe the rationale for, and development of a standardised clinical preoperative decision-support tool. Program description: An evidence-based, preoperative clinical decision tool was developed to guide preoperative testing and management of high-risk medications. Program evaluation: Patient data before and after implementation of the tool will be analysed to determine its effectiveness in reducing preoperative testing. Discussion Preoperative testing is an area that presents an opportunity to increase healthcare value and decrease healthcare spending. Guidelines are available to standardise preoperative assessment but their adoption and acceptance into practice has been slow. To systematise preoperative assessment within our healthcare system, we reviewed current published literature and guidelines and synthesised them into an electronic, evidence-based, decision-support tool. After distribution of the tool to clinicians in our healthcare system, we will assess its impact on healthcare value, costs and outcomes. We believe that an evidence-based preoperative tool, seamlessly and efficiently integrated into clinician workflow, can improve preoperative patient care.

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“…In fact, they may be ordered, required or performed on a selective basis for purposes of guiding or optimizing preoperative management. Instead of a shotgun approach, where “preop status” is just considered a specific clinical purpose, the indications for such laboratory testing should be based first on information from medical records, patient interview, physical examination and type and invasiveness of the surgical procedure ( 7 ).…”

Section: Discussionmentioning

confidence: 99%

“…In the light of the data obtained, it seems obvious that changes in pre-anaesthesia evaluation schemes must be introduced, moving towards a more “selective” approach regarding POTs. In summary, tests have to be always ordered (by surgeons and/or anaesthetists) after a previous consideration of specific information obtained from several medical sources and only if the information obtained will result in changes in the preoperative management of the patient ( 1 , 7 ). The main goal is to provide cost-effective quality patient care.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2017

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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.

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Preoperative Laboratory Testing

Cited by 30 publications

References 80 publications

Routine Postoperative Hemoglobin Assessment Poorly Predicts Transfusion Requirement among Patients Undergoing Minimally Invasive Radical Prostatectomy

Routine Postoperative Hemoglobin Assessment Poorly Predicts Transfusion Requirement among Patients Undergoing Minimally Invasive Radical Prostatectomy

Rationale and design of an evidence-based tool to guide preoperative evaluation and management

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

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