Relevância de exames de rotina em pacientes de baixo risco submetidos a cirurgias de pequeno e médio porte

Abstract

Background and objectives: Preoperative tests aim to reduce morbidity and mortality of surgical patients, cost of perioperative care, and preoperative anxiety. Clinical evaluation allows defi ning the need for additional tests and strategies to reduce the surgical-anesthetic risk. The aim of this study was to evaluate the benefi t of routine preoperative testing of low-risk patients undergoing minor and medium surgical procedures. Methods: A descriptive cross-sectional study of 800 patients seen at the preanesthetic assessment department of Hospital Santo Antonio, Salvador, BA. Patients with physical status ASA I, aged 1-45 years and scheduled to undergo elective minor and medium surgeries were include in the study. We evaluated changes in blood count, coagulation profi le, electrocardiogram, chest X-ray, blood sugar, kidney function, sodium and potassium levels, and eventual change in clinical approach occurring due to these changes. Results: Of 800 patients evaluated, a blood count was performed in 97.5%, coagulation in 89%t, electrocardiogram in 74.1%, chest X-ray in 62%, fasting glucose in 68%, serum urea and creatinine in 55.7%, and plasma levels of sodium and potassium in 10.1%. Of these 700 patients, 68 (9.71%) showed changes in preoperative routine tests and only 10 (14.7%) of the patients with abnormal tests had a preoperative modifi ed approach (i.e., new tests ordered, referral to a specialist or surgery postponement). No surgery was suspended. Conclusion: We found that preoperative additional tests are excessively ordered, even for young patients with low surgical risk, with little or no interference in perioperative management. Laboratory tests, besides generating high and unnecessary costs, are not good standardized screening instruments for diseases.

Impact of using a local protocol in preoperative testing: blind randomized clinical trial.

“…However, the medical literature has indicated that abnormalities found in POCEs are not usually clinically important, are generally ignored, do not contribute to changes in the anesthetic-surgical management and are not related to perioperative complications. In addition, there is a risk that non-clinically based tests, especially on the occurrence of false positives, may lead to further invasive investigations, leading to postponement of operations as well as inadequate treatment 3,5 .…”

Risk factors for surgical site infection in potentially contaminated surgeries

“…However, the influence of MAP in the development of SSI was not a predominant factor in the researched scientific studies 7,[15][16][17] .…”

Interface Entre Regulação Em Saúde E Equidade: Revisão Integrativa Da Literatura

“…O conceito de vulnerabilidade é entendido como a probabilidade de uma população ser atingida por problemas, ameaças, ou danos à saúde. Tal suscetibilidade leva à necessidade de priorização da assistência a tais eventos, promovendo, assim, o princípio da equidade (25) . A equidade é definida como a oferta de maior atenção aos indivíduos que mais a necessitam, provendo a cada um as ações de saúde segundo as suas demandas, com o intuito de superar as desigualdades existentes.…”

“…A superação do desafio de responder às demandas dos usuários utilizando os recursos que se têm disponíveis depende da eficácia e otimização dos recursos financeiros e do desenvolvimento de uma relação custo-benefício positiva (25) . O acesso às ações e serviços de saúde permite a integralidade do cuidado, por meio do fluxo do usuário pela rede de atenção à saúde, garantindo a oferta de serviços de diferentes densidades tecnológicas de acordo com sua necessidade (27) .…”