Redefining the role of routine postoperative bloodwork following uncomplicated bariatric surgery

Selvam, Rajajee; Jarrar, Amer; Meghaizel, Cynthia; Mamazza, Joseph; Neville, Amy; Walsh, Caolan; Kolozsvari, Nicole

doi:10.1007/s00464-022-09518-x

Cited by 2 publications

(4 citation statements)

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“…Avoidable expenditures were estimated at $C10 158 per year in our total study population of 304 patients. A recent quality improvement initiative eliminating postoperative day 1 bloodwork in bariatric surgery patients found similar savings of $C12 202 annually across 303 patients 41. Other studies have shown larger cost savings, up to US$2 million dollars ($C2.6 million) over 3 years across approximately 11 000 hospital admissions42 or 500 000 inpatient days 43.…”

Section: Discussionmentioning

confidence: 96%

“…A recent quality improvement initiative eliminating postoperative day 1 bloodwork in bariatric surgery patients found similar savings of $C12 202 annually across 303 patients. 41 Other studies have shown larger cost savings, up to US$2 million dollars ($C2.6 million) over 3 years across approximately 11 000 hospital admissions 42 or 500 000 inpatient days. 43 These interventions also demonstrated that reducing unnecessary testing does not adversely affect patient care, with no differences in emergency department presentations, readmissions, reoperations, missed diagnoses of anaemia or electrolyte disturbances or mortality.…”

Section: Discussionmentioning

confidence: 98%

“…Other studies have shown larger cost savings, up to US$2 million dollars ($C2.6 million) over 3 years across approximately 11 000 hospital admissions42 or 500 000 inpatient days 43. These interventions also demonstrated that reducing unnecessary testing does not adversely affect patient care, with no differences in emergency department presentations, readmissions, reoperations, missed diagnoses of anaemia or electrolyte disturbances or mortality 41–43. The cost saving potential of eliminating inappropriate testing is consistently underestimated; studies only account for the cost of consumables without capturing the downstream effects of further investigations, interventions or prolonged hospital stays.…”

Section: Discussionmentioning

confidence: 99%

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Patient, hospital and environmental costs of unnecessary bloodwork: capturing the triple bottom line of inappropriate care in general surgery patients

et al. 2023

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ObjectiveTo characterise the extent of unnecessary care in general surgery inpatients using a triple bottom line approach.DesignPatients with uncomplicated acute surgical conditions were retrospectively evaluated for unnecessary bloodwork according to the triple bottom line, quantifying the impacts on patients, healthcare costs and greenhouse gas emissions. The carbon footprint of common laboratory investigations was estimated using PAS2050 methodology, including emissions generated from the production, transport, processing and disposal of consumable goods and reagents.SettingSingle-centre tertiary care hospital.ParticipantsPatients admitted with acute uncomplicated appendicitis, cholecystitis, choledocholithiasis, gallstone pancreatitis and adhesive small bowel obstruction were included in the study. 304 patients met inclusion criteria and 83 were randomly selected for in-depth chart review.Main outcome measuresIn each patient population, the extent of over-investigation was determined by comparing ordered laboratory investigations against previously developed consensus recommendations. The quantity of unnecessary bloodwork was measured by number of phlebotomies, tests and blood volume in addition to healthcare costs and greenhouse gas emissions.Results76% (63/83) of evaluated patients underwent unnecessary bloodwork resulting in a mean of 1.84 phlebotomies, 4.4 blood vials, 16.5 tests and 18 mL of blood loss per patient. The hospital and environmental cost of these unnecessary activities was $C5235 and 61 kg CO2e (974 g CO2e per person), respectively. The carbon footprint of a common set of investigations (complete blood count, differential, creatinine, urea, sodium, potassium) was 332 g CO2e. Adding a liver panel (liver enzymes, bilirubin, albumin, international normalised ratio/partial thromboplastin time) resulted in an additional 462 g CO2e.ConclusionsWe found considerable overuse of laboratory investigations among general surgery patients admitted with uncomplicated acute surgical conditions resulting in unnecessary burden to patients, hospitals and the environment. This study identifies an opportunity for resource stewardship and exemplifies a comprehensive approach to quality improvement.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

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Patient, hospital and environmental costs of unnecessary bloodwork: capturing the triple bottom line of inappropriate care in general surgery patients

et al. 2023

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“…These can delay surgery, tend not to change risk estimates established through physical examination and history taking and lead to additional downstream testing which has risks to patients and healthcare costs. A recently published initiative to decrease routine postoperative bloodwork after uncomplicated bariatric surgery quantified patient outcomes, laboratory processing costs as well as environmental impact through the number of blood tubes saved from landfills 17. Similarly, toolkits are being developed for surgical departments to address the outsized waste and climate impact of operating rooms and surgical care which generate an estimated third of all hospital waste.…”

Section: Quality Improvement In the Clinical Environmentmentioning

confidence: 99%