Relevance of Routine Testing in Low-risk Patients Undergoing Minor and Medium Surgical Procedures

Soares, Danielle de Sousa; Brandão, Roberta Ribeiro Marques; Mourão, Mirla Rossana Nogueira; Azevedo, Vera Lucia Fernandes de; Figueiredo, Alexandre Vieira; Trindade, Eliomar Santana

doi:10.1016/j.bjane.2012.04.004

Cited by 9 publications

(21 citation statements)

References 12 publications

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“…Furthermore, positive findings do not necessarily produce a change in anesthetic practice. 32 Frequently, preoperative routine blood tests appear to be justified by legal, rather than medical, reasons. 33 Typically, undirected laboratory screening does not reveal unknown pathologies, even in patients with prevalent bleeding disorders, such as von Willebrand disease.…”

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confidence: 99%

Choosing Wisely in pediatric anesthesia: An interpretation from the German Scientific Working Group of Paediatric Anaesthesia (WAKKA)

Becke

Eich

Höhne

et al. 2018

Pediatric Anesthesia

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Inspired by the Choosing Wisely initiative, a group of pediatric anesthesiologists representing the German Working Group on Paediatric Anaesthesia (WAKKA) coined and agreed upon 10 concise positive ("dos") or negative ("don'ts") evidence-based recommendations. (i) In infants and children with robust indications for surgical, interventional, or diagnostic procedures, anesthesia or sedation should not be avoided or delayed due to the potential neurotoxicity associated with the exposure to anesthetics. (ii) In children without relevant preexisting illnesses (ie, ASA status I/II) who are scheduled for elective minor or medium-risk surgical procedures, no routine blood tests should be performed. (iii) Parental presence during the induction of anesthesia should be an option for children whenever possible. (iv) Perioperative fasting should be safe and child-friendly with shorter real fasting times and more liberal postoperative drinking and enteral feeding. (v) Perioperative fluid therapy should be safe and effective with physiologically composed balanced electrolyte solutions to maintain a normal extracellular fluid volume; addition of 1%-2.5% glucose to avoid lipolysis, hypoglycemia, and hyperglycemia, and colloids as needed to maintain a normal blood volume. (vi) To achieve safe and successful airway management, the locally accepted airway algorithm and continued teaching and training of basic and alternative techniques of ventilation and endotracheal intubation are required. (vii) Ultrasound and imaging systems (eg, transillumination) should be available for achieving central venous access and challenging peripheral venous and arterial access. (viii) Perioperative disturbances of the patient's homeostasis, such as hypotension, hypocapnia, hypothermia, hypoglycemia, hyponatremia, and severe anemia, should not be ignored and should be prevented or treated immediately. (ix) Pediatric patients with an elevated perioperative risk, eg, preterm and term neonates, infants, and critically ill children, should be treated at institutions where all caregivers have sufficient expertise and continuous clinical exposure to such patients. (x) A strategy for preventing postoperative vomiting, emergence delirium, and acute pain should be a part of every anesthetic procedure.

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confidence: 99%

Choosing Wisely in pediatric anesthesia: An interpretation from the German Scientific Working Group of Paediatric Anaesthesia (WAKKA)

Becke

Eich

Höhne

et al. 2018

Pediatric Anesthesia

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“…The high rate of abnormal electrocardiographic findings is not unique to this retrospective review; several other studies have found similar rates of abnormality [24−28]. In a prospective study evaluating the outcome of preoperative evaluations for ASA 1 patients undergoing elective noncardiac surgery, de Sousa Soares et al [24] found that 62% of patients underwent ECG preoperatively; 6.86% of tests were abnormal, and only 0.51% led to a change in patient management. Both studies provide evidence that the clinical usefulness of routine ECG in low-risk patients is negligible because the difference in cardiovascular death in patients with and without electrocardiographic abnormalities is very low [27].…”

Section: Electrocardiographymentioning

confidence: 60%

Preoperative Evaluation for Minimally Invasive Gynecologic Surgery: What Is the Best Evidence and Recommendations for Clinical Practice

Shields

Kho

2019

Journal of Minimally Invasive Gynecology

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Preoperative evaluation for elective benign gynecologic procedures is a necessary step in reducing perioperative complications. Although a thorough history and physical examination are the foundation of this assessment, much evidence exists that physicians rely on unnecessary laboratory and diagnostic testing. Our goal was to perform a systematic review of the available literature regarding preoperative evaluation to better inform preoperative test selection and to identify deficiencies in the current literature. There is very limited data specific to preoperative testing for patients undergoing gynecologic surgeries. Abnormal test results are common when routine, unselected testing is applied. Using a protocol to guide preoperative testing improves patient care by eliminating unnecessary tests without compromising the efficacy of predicting adverse perioperative events or case cancellation and modifications.

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“…In fact, our next step will involve the introduction of a clinical decision supporting rule (CDSR) through electronical request when ordering POTs in order to report and/or cancel tests when previous pathological results within 6 months are expected or known. Our study nowadays stands as one of the studies with more patients included as far as we know ( 8 , 9 ).…”

Section: Discussionmentioning

confidence: 99%

Utility of routine laboratory preoperative tests based on previous results: Time to give up

et al. 2017

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IntroductionThe usefulness and cost-effectiveness of routine laboratory preoperative tests (POTs) have been challenged recently. In fact, the American Society of Anesthesiologists (ASA) Task Force has stated that test results obtained from the medical record within 6 months of surgery generally are mostly acceptable. The aim of our study was to evaluate the degree of utility of POTs and their clinical benefit based on this recommendation.Material and methodsWe studied retrospectively every routine POT request from 8 randomly selected weeks in 2016. Every POT contained glucose, creatinine, haemoglobin and coagulation tests (PT-INR). Each pathological result for these tests was registered and classified as “expected” (if previous pathological result within 6 months existed for that test) or “unexpected” (if previous pathological result within 6 months did not exist for that test). Results of ASA physical status classification (a system for assessing the fitness of patients before surgery) and changes in patient management after POTs were retrieved from medical history as well.ResultsA total of 4516 tests (from 1129 patients) were analysed and 498 results were found pathological (11%). Of these, 403 were expected (8.9%) and 95 unexpected (2.1%). There was not any change in anaesthetic management for any patient due to these findings.ConclusionsRoutine POTs are an inefficient and low-value service. POTs have to be always ordered selectively after a previous consideration of specific information obtained from several sources (medical records, interviews, examinations, type of surgery) and only if the information obtained will result in changes in the management of the patient.

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Relevance of Routine Testing in Low-risk Patients Undergoing Minor and Medium Surgical Procedures

Cited by 9 publications

References 12 publications

Choosing Wisely in pediatric anesthesia: An interpretation from the German Scientific Working Group of Paediatric Anaesthesia (WAKKA)

Choosing Wisely in pediatric anesthesia: An interpretation from the German Scientific Working Group of Paediatric Anaesthesia (WAKKA)

Preoperative Evaluation for Minimally Invasive Gynecologic Surgery: What Is the Best Evidence and Recommendations for Clinical Practice

Utility of routine laboratory preoperative tests based on previous results: Time to give up

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