Evaluating Compliance with Institutional Preoperative Testing Guidelines for Minimal-Risk Patients Undergoing Elective Surgery

Abstract

Background. Few investigations preoperatively are important for low-risk patients. This study was designed to determine the level of compliance with preoperative investigation guidelines for ASA I patients undergoing elective surgery. Secondary objectives included the following: to identify common inappropriate investigations, to evaluate the impact of abnormal testing on patient management, to determine factors affecting noncompliant tests, and to estimate unnecessary expenditure. Methods. This retrospective study was conducted on adult patients over a one-year period. The institute's guidelines recommend tests according to the patients' age groups: a complete blood count (CBC) for those patients aged 18–45; CBC, chest radiograph (CXR) and electrocardiography (ECG) for those aged 46–60; and CBC, CXR, ECG, electrolytes, blood glucose, blood urea nitrogen (BUN), and creatinine (Cr) for patients aged 61–65. Results. The medical records of 1,496 patients were reviewed. Compliant testing was found in only 12.1% (95% CI, 10.5–13.9). BUN and Cr testings were the most frequently overprescribed tests. Overinvestigations tended to be performed on major surgery and younger patients. Overall, overinvestigation incurred an estimated cost of US 200,000 dollars during the study period. Conclusions. The need to utilize the institution's preoperative guidelines should be emphasized in order to decrease unnecessary testing and the consequential financial burden.

Use of Preoperative Testing and Physicians’ Response to Professional Society Guidance

“…Our findings are consistent with the conclusions of previous studies that report overuse of testing in the pre-operative setting, including studies of pre-operative cardiac stress test use among patients with Medicare, 2 medical consultations for cataract surgery, 3 and testing prior to hernia repair, 1 among other studies. 9,20 Though we found little evidence of guideline impact, it is noteworthy that rates of pre-operative testing have generally fallen over time. This likely reflects strong secular trends in testing, and may have been partially driven by temporal reductions in reimbursement.…”

Duplicate Type and Screen Testing: Waste in the Clinical Laboratory

“…Extension of TS expiration dates in outpatients who have not undergone transfusion significantly reduces the number of elective surgery patients going to the operating room without a valid TS. 23 Computerized decision support systems 24 and involvement of the anesthesiology team in presurgical planning 25 have also been shown to be beneficial in providing evidence-based presurgical testing. As well as studying services with high rates of inappropriate duplicate testing, it may also be beneficial to examine why some services have lower rates of inappropriate orders.…”

Variation in Practice of the Diagnostic Workup of Asymptomatic Patients Diagnosed with Invasive Breast Cancer

“…Interestingly, they found that surgeons, more than anesthesiologists, order tests as a matter of routine resulting in a net increase in the cost per patient of 33.6% ( 27 ). Similarly, in a study of 1496 patients in Thailand, Siriussawakul et al found that only 12.1% of patients had preoperative workups that were in accordance with guidelines, with CMP/electrolytes being the most commonly ordered unnecessary test ( 26 ). In the UK, Phoenix et al estimated that inappropriate preoperative blood work resulted in an extrapolated cost of £11.2 million per year ( 28 ).…”