Preoperative Investigations: Practice Guidelines from the Indian Society of Anaesthesiologists

Umesh, Goneppanavar; Bhaskar, S Bala; Harsoor, SS; Dongare, Pradeep A; Garg, Rakesh; Kannan, Sudheesh; Ali, Zulfiqar; Nair, Abhijit; Bhure, Anjali; Grewal, Anju; Rao, Durga Prasad; Divatia, Jigeeshu Vasishtha; Sinha, Mahesh; Kumar, M.; Joshi, Meera; Shastri, Naman; Malhotra, Naveen; Saikia, Priyam; Rajesh, MC; Das, Sushmita; Ghosh, Santu; Subramanyam, Malavika A.; Tantry, Thrivikrama Padur; Mangal, Vandana; Keshavan, Venkatesh H

doi:10.4103/ija.ija_335_22

Cited by 11 publications

(15 citation statements)

References 70 publications

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“…The National Institute of Health and Care Excellence (NICE), United Kingdom guidelines clearly advise that the primary factors used to determine which preoperative investigations are appropriate would be the patient’s clinical history and examination, the ASA grade, and the intended surgical intervention [ 15 ]. Given the current financial constraints globally, even in developing countries such as India, the Society of Anesthesiologists has recently published very clear guidelines regarding what investigations are indicated preoperatively for different categories of surgeries and patients [ 16 ]. However, in addition to publishing guidelines, any update of the clinical guidelines must also be followed by an educational initiative.…”

Section: Discussionmentioning

confidence: 99%

An Economic Evaluation of the Preoperative Investigations for Elective Surgical Patients at a Caribbean Tertiary Care Teaching Hospital

Hinds¹,

Hariharan²

2023

Cureus

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IntroductionPreoperative assessment using widespread laboratory investigations and ancillary tests as preoperative screening may be unnecessary and lead to an economic burden. This study aimed to determine the routine preoperative investigations performed in a tertiary care teaching hospital in the Caribbean that could be categorized as unnecessary and the costs incurred for these tests. MethodsPatient and surgery-specific data were collected prospectively from adult elective surgery patients over a three-month period. Surgical intensity, American Society of Anesthesiologists (ASA) grade and the National Institute for Health and Care Excellence (NICE) (UK, 2016) Clinical Guideline for Preoperative Investigations were used to determine which tests to deem unnecessary. The overall economic burden of unnecessary testing was assessed. ResultsData were prospectively collected from 636 patients during the study period. Sixty-four percent of the preoperative investigations performed were deemed unnecessary. The money spent on these unnecessary investigations amounted to $44,622. When extrapolated, this can amount to approximately $178,488 per annum. This represented 59% of the total money spent on the overall preoperative investigations performed. Relatively healthier patients (ASA I and II) had a significantly higher number of unnecessary investigations performed. ConclusionThis study found that the majority of preoperative investigations performed routinely may be deemed unnecessary. This results in a huge economic burden on the healthcare system. There is a need to update and strictly implement clinical guidelines for preoperative investigations.

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Section: Discussionmentioning

confidence: 99%

An Economic Evaluation of the Preoperative Investigations for Elective Surgical Patients at a Caribbean Tertiary Care Teaching Hospital

Hinds¹,

Hariharan²

2023

Cureus

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“…In the year 2022, the Indian Society of Anesthesiologists (ISA) published the guidelines for preoperative investigations considering the socio-economic, demographic, and medico-legal aspects of the Indian scenario [ Table 5 ]. [ 31 ] The guidelines are unique in that they mention the acceptable validity time for a previously performed investigation. So far, no guidelines by any professional bodies across the world have mentioned this.…”

Section: Methods Of Pre-anaesthetic Evaluationmentioning

confidence: 99%

“…If a previously taken 12-lead electrocardiogram and chest radiogram were normal, then it is valid for 12 months provided the clinical condition of the patient has not changed during the period. [ 31 ] Considerations for ordering preoperative serum chemistry can be perioperative therapies, endocrine disorders, and the risk of renal and liver diseases.…”

Section: Methods Of Pre-anaesthetic Evaluationmentioning

confidence: 99%

Update on preoperative evaluation and optimisation

et al. 2023

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The patients presenting for surgery today often belong to the extremes of age, have multiple co-morbidities, and undergo complex surgeries. This makes them more prone to morbidity and mortality. A detailed preoperative evaluation of the patient can contribute to reducing this mortality and morbidity. There are various risk indices and validated scoring systems and many of them need to be calculated using preoperative parameters. Their key objective is to identify patients vulnerable to complications and to return them to desirable functional activity as soon as possible. Any individual undergoing surgery should be optimised preoperatively, but special considerations should be given to patients with comorbidity, on multiple drugs, and undergoing high-risk surgery. The objective of this review is to put forth the latest trends in the preoperative evaluation and optimisation of patients undergoing noncardiac surgery and emphasise the importance of risk stratification in these patients.

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“…Our own national guidelines on preoperative investigations mention that preoperative blood glucose estimation is not recommended in American Society of Anesthesiologists (ASA) grade I and II patients without a known history of diabetes undergoing any type of surgery. [ 10 ] However, several authors say that screening for diabetes is recommended in every patient being planned for surgery. [ 11 ] The preoperative assessment of diabetes control is done using glycosylated haemoglobin (HbA1c), and higher HbA1c values are closely related to morbidity, cardiac injury, postsurgical infection and mortality.…”

Section: Preoperative Glucose Controlmentioning

confidence: 99%