Routine pre‐operative blood testing: is it necessary?

Johnson, Rosamund; Mortimer, A.J.

doi:10.1046/j.1365-2044.2002.02750.x

Cited by 64 publications

(75 citation statements)

References 10 publications

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“…Recent literature suggests that preoperative laboratory testing should be based on clinical examination rather than routine protocols [1][2][3][4][5][6]. Preoperative hemoglobin test or screening for anemia is included in most of the hospitals preoperative testing protocols in third world countries despite the fact that routine laboratory tests for all patients are not good screening device for diseases [3].…”

Section: Introductionmentioning

confidence: 99%

“…These unexpected abnormal results have very little impact on the anesthetic management if at all [4,[6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

“…The history should include a complete review of systems, medication history, surgical and anesthetic history, history of allergies and functional status. The physical examination and laboratory tests should be focused on information gathered from the history [1][2][3][4][5][6].…”

Section: Introductionmentioning

confidence: 99%

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Can Simple Preoperative Hemoglobin Testing Screen Symptomatic Anemia in Patients Undergoing Ambulatory Surgeries in Third World Countries?

Khan¹,

Khan²,

Samad³

2012

OJAnes

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Background: Patients coming for ambulatory surgeries are mostly healthy adults and asymptomatic anemia in these patients is rare. According to international standards, perioperative period is not an appropriate setting to screen and investigate the cause of asymptomatic anemia, but in third world countries where iron deficiency is rampant, it is generally required as per local hospitals policy to test hemoglobin levels prior to any surgery in order to prevent morbidity. The purpose of our study is to look at the prevalence of anemia in patient undergoing minor elective ambulatory surgeries. Method: This was a cross sectional observational study conducted at tertiary care unit, Karachi, Pakistan. A total of 385 ASA-I (American Society of Anesthesiologist) and II patient's age ranged 18 -60 years, scheduled for day care surgical procedures were enrolled in the study. Results: Anemia was detected in 74 (19.2%) patients and its prevalence was found to be higher in females and in patients above 50 years of age. However, the presence of anemia did not have any influence on the perioperative outcomes or management. Conclusion: The routine preoperative hemoglobin testing does not have any effect on the perioperative outcomes in asymptomatic patients who are planned for elective day care surgeries.

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Section: Introductionmentioning

confidence: 99%

“…These unexpected abnormal results have very little impact on the anesthetic management if at all [4,[6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Can Simple Preoperative Hemoglobin Testing Screen Symptomatic Anemia in Patients Undergoing Ambulatory Surgeries in Third World Countries?

Khan¹,

Khan²,

Samad³

2012

OJAnes

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show abstract

“…In a previous cohort study of 73,596 patients undergoing elective, low-risk ambulatory surgery, abnormal pre-anesthetic laboratory findings were not predictive of postoperative outcomes when compared with normal results [3]. Several studies have investigated the usefulness of preoperative screening tests in adult patients [4][5][6], however, there are scarce data for evaluation of routine pre-anesthetic AST and ALT testing in pediatric patients.…”

Section: Introductionmentioning

confidence: 99%

Analysis of pre-operative aspartate aminotransferase and alanine aminotransferase in 14,185 pediatric patients

Lee¹,

Lee²,

Chang³

et al. 2015

Anesth Pain Med

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This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Background:The aim of this study was to investigate the efficacy of routine pre-anesthetic aspartate aminotransferase (AST) and alanine aminotransferase (ALT) tests for detection of hepatic abnormalities and usefulness in perioperative management. Methods: The laboratory findings of 14,185 pediatric patients younger than 18 years from October 2004 to December 2010 were investigated by retrospective review of medical records. All of the patients had undergone preoperative AST and ALT screening. Results: Among the 14,185 patients, 221 patients experienced elevation of both AST and ALT. However, only 21 patients were suspicious for hepatic disease defined as persistent elevation of AST and ALT preoperatively. Among the 221 patients with elevation of both AST and ALT, 20 patients were examined by additional abdominal ultrasonography and hepatic abnormalities were detected in 13 of these patients (65%) and 40 patients were consulted to the department of pediatrics or internal medicine. Conclusions: In this single-center, retrograde study, the usefulness of preoperative routine AST and ALT testing was shown to be limited for detection of hepatic abnormalities in pediatric patients undergoing general anesthesia. Further multi-center, large-scale investigation would be required. (Anesth Pain Med 2015; 10: 284-287)

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“…5,6 Preoperative evaluation is an area of practice where unnecessary expenses have been recognized. [7][8][9][10][11] Routine ordering of preoperative tests in the absence of specific indications rarely contributes to patient care and is not cost-effective. [7][8][9][10][11][12] A prior study of patients undergoing elective surgery showed that 60% of routinely ordered tests were unnecessary.…”

Section: Introductionmentioning

confidence: 99%

A Clinical Process Change and Educational Intervention to Reduce the Use of Unnecessary Preoperative Tests

Richards¹,

Shiffermiller²,

Wells³

et al. 2014

Journal of Graduate Medical Education

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Background Internal medicine residents receive limited training on how to be good stewards of health care dollars while preserving high-quality care. Intervention We implemented a clinical process change and an educational intervention focused on the appropriate use of preoperative diagnostic testing by residents at a Veterans Administration (VA) medical center. Methods The clinical process change consisted of reducing routine ordering of preoperative tests in the absence of specific indications. Residents received a short didactic session, which included algorithms for determining the appropriate use of perioperative diagnostic testing. One outcome was the average cost savings on preoperative testing for a continuous cohort of patients referred for elective knee or hip surgery. Resident knowledge and confidence prior to and after the intervention was measured by pre- and posttest. Results The mean cost of preoperative testing decreased from $74 to $28 per patient after the dual intervention (P < .001). The bulk of cost savings came from elimination of unnecessary blood and urine tests, as well as reduced numbers of electrocardiograms and chest radiographs. Among residents who completed the pretest and posttest, the mean score on the pretest was 54%, compared with 80% on the posttest (P = .027). Following the educational intervention, 70% of residents stated they felt “very comfortable” ordering appropriate preoperative testing (P = .006). Conclusions This initiative required few resources, and it simultaneously improved the educational experience for residents and reduced costs. Other institutions may be able to adopt or adapt this intervention to reduce unnecessary diagnostic expenditures.

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Routine pre‐operative blood testing: is it necessary?

Cited by 64 publications

References 10 publications

Can Simple Preoperative Hemoglobin Testing Screen Symptomatic Anemia in Patients Undergoing Ambulatory Surgeries in Third World Countries?

Can Simple Preoperative Hemoglobin Testing Screen Symptomatic Anemia in Patients Undergoing Ambulatory Surgeries in Third World Countries?

Analysis of pre-operative aspartate aminotransferase and alanine aminotransferase in 14,185 pediatric patients

A Clinical Process Change and Educational Intervention to Reduce the Use of Unnecessary Preoperative Tests

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