Elimination of Unnecessary Preoperative Laboratory Tests

Kaplan, E. B.; Boeckmann, A. S.; Roizen, Michael F.; Sheiner, Lewis B.

doi:10.1097/00000542-198209001-00445

Cited by 30 publications

(8 citation statements)

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“…Sandler (1979) found routine blood counts and urinalysis helpful in less than 1% of medical outpatients presenting for diagnosis. Kaplan et al (1982) found no haemoglobin abnormalities, one platelet, and one white blood cell abnormality in 610 blood counts in healthy subjects. Robbins & Rose (1979) found no unpredicted partial thromboplastin times in 1025 studies.…”

Section: Discussionmentioning

confidence: 71%

Rational preoperative evaluation

Muskett¹,

McGreevy²

1986

Postgraduate Medical Journal

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Summary:Clinical data from two hundred consecutive patients undergoing surgical procedures at the Salt Lake City VA Hospital form the basis of this study. Results of nine commonly ordered preoperative tests (blood count, differential, electrolytes, chemistry panel, urinalysis, prothrombin time, partial thromboplastin time, electrocardiogram, and chest X-ray) were matched with the preoperative history and physical examination and the outcome of surgery in each patient. Each test was examined by (1) the frequency with which it was ordered, (2) the frequency with which it was abnormal, and (3) the frequency with which the abnormal result affected preoperative care. A prevalence ofmedical illness was found in this population, with 47.5% having a major cardiovascular diagnosis, 35.5% a metabolic or endocrine disease, and 28% a major pulmonary diagnosis.A total of 1271 tests were performed, with 477 (35.5%) showing some abnormality. However, only 76 (5.9%) changed the patient's management before surgery. All but five of these abnormalities were predictable from the clinical evaluation and these five were minor. The overall postoperative complication rate was 9%. No complication was attributed to the omission ofa preoperative test. No surgical cases were cancelled during the study period based solely on a preoperative test. We conclude that many preoperative tests can be safely eliminated by ordering only those based on a specific abnormality in the history or physical examination, resulting in more cost-effective surgical care.

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Section: Discussionmentioning

confidence: 71%

Rational preoperative evaluation

Muskett¹,

McGreevy²

1986

Postgraduate Medical Journal

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“…The value of routine preoperative screening of healthy patients is increasingly being questioned. While many physicians believe that all cataract surgery patients should receive a thorough preoperative medical assessment for concurrent medical problems [23], others recommend a more elective use, since several studies indicate that medical tests rarely detect significant abnormalities in such patients, and, when detected, the abnormalities rarely influence 321 management [14][15][16][17][18][19][20]. Research on the value of preoperative screening tests indicates that this is an area where costs can be cut without compromising care [10].…”

Section: Discussionmentioning

confidence: 99%

“…However, newer techniques for evaluating visual disfunction caused by cataract, being generally used in clinical practice, had not been thoroughly evaluated before. The clinical value of routine preoperative screening of healthy patients is increasingly questioned in literature [10,[14][15][16][17][18][19], as a result of their aggregate cost and relatively low yield [20]. There is also little information regarding the extent of variation in ophthalmologists' use of ophthalmic and medical tests prior to cataract surgery [6].…”

Section: Introductionmentioning

confidence: 99%

Preoperative testing practice in healthy cataract surgery patients. Results of a survey of ophthalmologists in Barcelona, Spain

1997

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Aims~Background: Many preoperative ophthalmic and medical tests lack proven effectiveness in the evaluation of cataract surgery patients. Variation in use has been described in the USA, but little information is available for countries with different health systems. The objectives of the study were to assess variation in ophthalmologists' use of preoperative testing on cataract surgery patients and to identify ophthalmologists' characteristics associated with it. Methods: A postal survey was made in a representative sample (response rate of 70%) of the Barcelona Medical Association of Ophthalmologists performing cataract surgery during 1993 (N --89). The questionnaire included information about common preoperative, intraoperative and postoperative practice and sociodemographic and professional data. Appropriateness of preoperative ophthalmic tests was classified in 3 levels (indicated tests, tests with unproven benefit, and non-indicated tests) according to recommendations of the Cataract Management Guideline Panel [ 1] and the American Academy of Ophthalmology Preferred Practice Pattern [2]. Results: Almost all the ophthalmologists reported performing Fundus exam plus A-scan in the preoperative evaluation of cataract surgery patients (indicated tests). Up to 20% reported performing 'frequently' or 'always' some non-indicated or unproven benefit ophthalmic tests. Additionally, an average of 7 medical tests were 'routinely' included. Private practice and cataract subspeciality were the ophthalmologists' characteristics more frequently associated with the use of inappropriate ophthalmic tests (p < 0.05). Conclusions: In Barcelona, Spain, some ophthalmic tests of unproven effectiveness are frequently performed preoperatively on cataract surgery patients without ocular comorbidity. Also, a generalized utilization of several medical tests was reported. There is potential for some cost containment and more appropriate care of cataract patients without diminishing the quality of care, in a location with low surgery rates.

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“…Of the 69 ASA respondents, 19 (28%) were ineligible because they had not provided anesthesia care to a patient undergoing cataract surgery in 1991. Of the 83 anesthesiologists in the OAS to whom questionnaires were mailed, 11 (13%) could not be contacted, seven (8%) refused to complete the questionnaire, and 65 completed the ques¬ tionnaire, yielding a response rate of 78%. Of these 65 OAS respondents, six (9%) were ineligible because they had not provided anesthesia care for any patient under¬ going cataract surgery in 1991.…”

Section: Response To Surveymentioning

confidence: 99%