The Usefulness of Preoperative Laboratory Screening

Abstract

We assessed the usefulness of routine laboratory screening of preoperative patients. Computer-readable laboratory, demographic, and discharge diagnostic data were assembled for 2,000 patients undergoing elective surgery over a four-month period, and randomly selected samples of patients were studied. Several tests ordered by protocol and performed by the laboratory at the time of admission were examined in these samples, including complete blood cell count, differential cell count, prothrombin time, partial thromboplastin time, platelet count, six-factor automated multiple analysis, and glucose level. Sixty percent of these routinely ordered tests would not have been performed if testing had only been done for recognizable indications, and only 0.22% of these revealed abnormalities that might influence perioperative management. Chart review indicated that these few abnormalities were not acted on nor did they have adverse surgical or anesthetic consequences. In the absence of specific indications, routine preoperative laboratory tests contribute little to patient care and could reasonably be eliminated.

Preoperative Thrombocytopenia and Postoperative Outcomes after Noncardiac Surgery

“…[10][11][12][13][14][15][16][17][18][19] However, most of these studies are based on relatively small patient cohorts, which may be inadequately powered to support such a conclusion.…”

“…From this sample, we identified patients without any one of the following clinical indications for preoperative platelet testing 12 : self-reported history of a bleeding disorder (vitamin K deficiency, hemophilia, thrombocytopenia, chronic anticoagulation therapy that has not been discontinued before surgery), hemorrhage (preoperative transfusion of >4 units of blood), chemotherapy in the 30 days before surgery, radiation therapy within 90 days of surgery, severe infections (systemic inflammatory response syndrome, sepsis, septic shock), liver disease (ascites, esophageal varices), steroid use, malnutrition (>10% decrease in body weight in the 6 months before surgery), renal failure, or disseminated cancer (405,343). We excluded records with no platelet counts (71,276), no hematocrits (838), procedures with work relative value units equal to zero (7,790), missing demographic information (7,780), missing American Society of Anesthesiologist Physical Status (428), and missing information on blood transfusion (547), to yield an analytic sample of 316,644 records of patients without clinical indications for coagulation testing ( fig.…”

“…In a single-center retrospective study of 2,000 elective surgical patients, 60% of preoperative testing was designated as routine screening; only four of the test results were considered abnormal and none influenced perioperative care. 12 In a retrospective case-control study of 828 patients having noncardiac surgery, Ng et al 18 found that coagulation abnormalities were associated with blood transfusion, but that nearly all coagulation abnormalities occurred in patients with clinical indications for testing. Houry et al 16 conducted a prospective multicenter study of 3,242 general surgery patients, in which they found no changes in blood use, blood drainage, reoperations to control hemorrhage, and mortality in the 340 patients with abnormal coagulation tests and no clinical abnormalities, compared with patients with normal coagulation parameters.…”

Laboratory Evaluation of Jaundice in Newborns

“…The database has been described in previous re¬ ports. 6,7 The database includes patients discharged from UCSF between October 1, 1980, and September 30,1982. We restricted our atten¬ tion to infants who were born at UCSF and discharged within the 2-year period.…”

Preoperative testing practice in healthy cataract surgery patients. Results of a survey of ophthalmologists in Barcelona, Spain

“…However, newer techniques for evaluating visual disfunction caused by cataract, being generally used in clinical practice, had not been thoroughly evaluated before. The clinical value of routine preoperative screening of healthy patients is increasingly questioned in literature [10,[14][15][16][17][18][19], as a result of their aggregate cost and relatively low yield [20]. There is also little information regarding the extent of variation in ophthalmologists' use of ophthalmic and medical tests prior to cataract surgery [6].…”