Use of Preoperative Laboratory Testing Among Low-Risk Patients Undergoing Elective Anorectal Surgery

Abstract

Background: Many low-risk patients receive preoperative laboratory testing (PLT) prior to elective outpatient surgery, with no effect on postoperative outcomes. This has not been studied in patients undergoing anorectal surgery. The aim of this study was to determine if PLT in this population was predictive of perioperative complications. Materials and Methods:The 2015-2018 National Surgical Quality Improvement Program (NSQIP) databases were queried for elective ambulatory anorectal surgeries. PLT was defined as chemistry, hematology, coagulation, or liver function studies obtained ≤30 days preoperatively. American Society of Anesthesiologists (ASA) class 1 and 2 patients were included who underwent elective, ambulatory, benign anorectal surgery. Patient demographics, comorbidities, and postoperative outcomes were compared between those who did and did not receive PLT. Postoperative outcomes were defined as wound-related, procedure-related, major complications, unplanned readmission, and death occurring within 30 days. Multivariate regression analysis determined patient characteristics predictive of receiving testing.Results: Of 3309 patients studied, 48.6% received PLT. On multivariate analysis, older age, female sex, Black race, ASA class 2, and comorbidities were predictive of receiving testing.The complication rates were similar between patients who did and did not receive testing (4.3% versus 3.5%, P = 0.22).Conclusions: PLT is performed in over half of low-risk patients receiving elective anorectal surgery. There was no difference in the rate of postoperative complications between patients who received testing or not, nor with normal versus abnormal results. PLT can be used more judiciously in this population.

The deimplementation of laboratory testing in low‐risk patients as recommended by the American society of anesthesiologists: An ACS‐NSQIP longitudinal analysis

“…Several institutions have evaluated their independent practices and found persistently high utilization of routine preoperative testing. 13,14 This finding has been further identified in various national cohorts [15][16][17][18][19][20][21][22] culminating in the 2022 study by Taylor et al using 2017 ACS-NSQIP data from 111,589 low-risk patients, which demonstrated that 51.6% of low-risk patients received at least one preoperative laboratory test. 12 The present study adds an assessment of 8 years prior and 6 years following the introduction of the ASA guidelines equating to an analysis of 972,431 low-risk patients, suggesting that the majority of low-risk patients continue to undergo testing not recommended by the ASA.…”

“…Several institutions have evaluated their independent practices and found persistently high utilization of routine preoperative testing 13,14 . This finding has been further identified in various national cohorts 15–22 culminating in the 2022 study by Taylor et al. using 2017 ACS‐NSQIP data from 111,589 low‐risk patients, which demonstrated that 51.6% of low‐risk patients received at least one preoperative laboratory test 12 .…”

Development and Validation of a Risk‐Prediction Nomogram for Preoperative Blood Type and Antibody Testing in Spinal Fusion Surgery

“…However, evidence suggests that routine laboratory tests are not necessary for screening: studies have shown that in almost 50% of cases, routine laboratory screening (such as routine blood and urine tests, blood grouping, chest X‐ray, and electrocardiogram) is not indicated for some patients. 8 , 9 , 10 In another study, although 12% of clinical tests were abnormal, only 0.5% of abnormal results affected clinical decision‐making. 11 In another study evaluating preoperative laboratories in patients undergoing posterior spinal fusion for idiopathic scoliosis, Clark et al 12 found that 94.9% of patients had one or more abnormal preoperative laboratory values, but only 11.7% of patients took further measure.…”

“…In the age of value‐first medicine, preoperative screening has been justified by citing concerns about patient safety and medico‐legal risks, the perception that other doctors expect preoperative testing, and that the medical benefits outweigh the medical risks, thereby making them cost‐effective. However, evidence suggests that routine laboratory tests are not necessary for screening: studies have shown that in almost 50% of cases, routine laboratory screening (such as routine blood and urine tests, blood grouping, chest X‐ray, and electrocardiogram) is not indicated for some patients 8–10 . In another study, although 12% of clinical tests were abnormal, only 0.5% of abnormal results affected clinical decision‐making 11 .…”

Current practice of pre-operative assessment at a public sector hospital in Pakistan – a clinical audit

“…After taking informed consent, data was collected using a self-administered questionnaire that was developed after extensive literature review of previous related studies. [7][8][9]11,12 The questions relevant to the study were asked specific to laboratory, radiology and cardiology investigations conducted as part of the preoperative assessment at our institution. All efforts were made to make it brief and participant-friendly.…”