Comprehensive History and Physicals are Common Before Low-Risk Surgery and Associated With Preoperative Test Overuse

Metz, Allan K.; Berlin, Nicholas L.; Yost, Monica; Cheng, Bonnie; Kerr, Eve A.; Nathan, Hari; Cuttitta, Anthony; Henderson, James; Dossett, Lesly A.

doi:10.1016/j.jss.2022.10.019

Cited by 2 publications

(3 citation statements)

References 32 publications

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“…LFTs were advised by 42% of the surgeons among whom orthopaedic surgeons and gynaecologists were the leads (70-75%). However, the guidelines recommend assessing liver function both by clinical grading system, such as Model for End-Stage Liver Disease (MELD) score, Child-Pugh score, and by dynamic biochemical parameters for patients undergoing liver surgeries for better surgical decision-making [16][17][18][19] .…”

Section: Discussionmentioning

confidence: 99%

Current practice of pre-operative assessment at a public sector hospital in Pakistan – a clinical audit

Urooj,

Mughal,

Siddiqui

et al. 2024

J Pak Med Assoc

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Objective: To assess the practice of ordering unnecessary laboratory investigations by primary surgical teams. Method: The clinical audit was conducted from December 17, 2022, to January 15, 2023, at the Civil Hospital, Karachi, and comprised primary surgeons working in different surgical units who ordered laboratory investigations for patients as a part of preoperative assessment. Data was collected using a self-administered questionnaire. Data was analysed using SPSS 20. Results: Of the 280 surgeons approached, 249(89%) responded. The units covered were General surgery 96(38.5%), Gynaecology 74(29.7%), Neurosurgery 5(2.0%), Ear, Nose and Throat 19(7.6%), Plastic surgery 15(6.02%), Paediatric surgery 13(5.2%), Vascular surgery 8(3.21%), Oromaxilofacial 9(3.61%), Opthalmology 6(2.4%), and Orthopaedics 4(1.60%).As part of baseline investigations, 244(98%) surgeons ordered complete blood count, 173(69.5%) ordered urea and creatinine, 229(92%) ordered viral markers, 197(78.7%) ordered fasting and random blood glucose, and 178(71.5%) focussed on cardiac fitness. Conclusion: There was a found a need for standard protocols for pre-surgery evaluation so that unnecessary investigations may be avoided. Key Words: Preoperative, Investigation, Guidelines, Assessment, Audit.

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Section: Discussionmentioning

confidence: 99%

Current practice of pre-operative assessment at a public sector hospital in Pakistan – a clinical audit

Urooj,

Mughal,

Siddiqui

et al. 2024

J Pak Med Assoc

View full text Add to dashboard Cite

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“…[3][4][5] Abnormal or false-positive results do not affect anesthesia or perioperative management; however, they can increase costs and patient anxiety. 6,7 In the age of value-first medicine, preoperative screening has been justified by citing concerns about patient safety and medico-legal risks, the perception that other doctors expect preoperative testing, and that the medical benefits outweigh the medical risks, thereby making them cost-effective. However, evidence suggests that routine laboratory tests are not necessary for screening: studies have shown that in almost 50% of cases, routine laboratory screening (such as routine blood and urine tests, blood grouping, chest X-ray, and electrocardiogram) is not indicated for some patients.…”

Section: Introductionmentioning

confidence: 99%

“…Routine preoperative laboratory testing may lead to more tests, consultations, and treatments that ultimately increase costs without reducing adverse events or improving outcomes 3–5 . Abnormal or false‐positive results do not affect anesthesia or perioperative management; however, they can increase costs and patient anxiety 6,7 . In the age of value‐first medicine, preoperative screening has been justified by citing concerns about patient safety and medico‐legal risks, the perception that other doctors expect preoperative testing, and that the medical benefits outweigh the medical risks, thereby making them cost‐effective.…”

Section: Introductionmentioning

confidence: 99%

Development and Validation of a Risk‐Prediction Nomogram for Preoperative Blood Type and Antibody Testing in Spinal Fusion Surgery

Wu,

Peng,

Zhuo

et al. 2023

Orthopaedic Surgery

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ObjectiveWith advancements in minimally invasive techniques, the use of spinal fusion surgery is rapidly increasing and transfusion rates are decreasing. Routine preoperative ABO/Rh blood type and antibody screening (T&S) laboratory tests may not be appropriate for all spinal fusion patients. Herein, we constructed a nomogram to assess patient transfusion risk based on various risk factors in patients undergoing spinal fusion surgery, so that preoperative T&S testing can be selectively scheduled in appropriate patients to reduce healthcare and patient costs.MethodsPatients who underwent spinal fusion surgery between 01/2020 and 03/2023 were retrospectively examined and classified into the training (n = 3533, 70%) and validation (n = 1515, 30%) datasets. LASSO and multivariable logistic regression were used to analyze risk factors for blood transfusion. Nomogram predictive model was built according to the independent predictors and mode predictive power was validated using consistency index (C‐index), Hosmer–Lemeshow (HL) test, calibration curve analysis and area under the curve (AUC) for receiver operating characteristic (ROC) curve. Bootstrap resampling was used for internal validation. Decision curve analysis (DCA) was applied to evaluate the model's performance in the clinic.ResultsBeing female, age, BMI, admission route, critical patient, operative time, heart failure, end‐stage renal disease or chronic kidney disease (ESRD or CKD), anemia, and coagulation defect were predictors of blood transfusion for spinal fusion. A prediction nomogram was developed according to a multivariate model with good discriminatory power (C‐index = 0.887); Bootstrap resampling internal validation C‐index was 0.883. Calibration curves showed strong matching between the predicted and actual probabilities of the training and validation sets. HL tests for the training and validation sets had p‐values of 0.327 and 0.179, respectively, indicating good calibration. When applied to the training set, the following parameters were found: AUC: 0.895, 95% CI: 0.871–0.919, sensitivity 78.2%, specificity 86.7%, positive predictive value 29.4% and negative predictive value 98.2%. If the model were applied in the training set, 2911 T&S tests (82.4%) would be eliminated, equaling a RMB349,320 cost reduction. The AUC in the internal validation was: 0.879, 95% CI: 0.839–0.927, sensitivity 75.2%, specificity 88.8%, positive predictive value 34.3%, negative predictive value 97.9%, would eliminate 1276 T&S tests (84.2%), saving RMB 153,120. The DCA curve indicated good clinical application value.ConclusionThe nomogram based on 10 independent factors can help healthcare professionals predict the risk of transfusion for patients undergoing spinal fusion surgery to target preoperative T&S testing to appropriate patients and reduce healthcare costs.

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Comprehensive History and Physicals are Common Before Low-Risk Surgery and Associated With Preoperative Test Overuse

Cited by 2 publications

References 32 publications

Current practice of pre-operative assessment at a public sector hospital in Pakistan – a clinical audit

Current practice of pre-operative assessment at a public sector hospital in Pakistan – a clinical audit

Development and Validation of a Risk‐Prediction Nomogram for Preoperative Blood Type and Antibody Testing in Spinal Fusion Surgery

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