Utility of Routine Postoperative Laboratory Studies in Patients Undergoing Potentially Curative Resection for Adenocarcinoma of the Colon and Rectum

Abstract

In an effort to lower healthcare costs, this study was undertaken to evaluate the utility of routine postoperative (PO) laboratory studies and determine whether abnormalities alter patient (PT) care. This was a retrospective review of 105 PTs undergoing elective curative resection for colorectal cancer. A serum electrolyte and liver panel and a hematologic panel were drawn in all PTs. OF 8749 total laboratory values obtained, 5894 (67%) were normal. Two of these (0.03%) elicited a therapeutic intervention. Of the 2004 values that were low (23%), 103 (5.1%) elicited a therapeutic response. Of the 851 that were high (10%), 21 (2.5%) elicited a therapeutic response. Of 2089 preoperative laboratory values, 252 (12%) were abnormal, but in only 15 incidences in 9 PTs was any action taken. Three PTs required potassium supplementation and 6 PTs were transfused packed red blood cells before surgery. In the PO period 2603 laboratory values of 6660 obtained (39%) were abnormal. Of these, 735 (28%) were high and 1868 (72%) were low. Twenty of 735 (27%) high values triggered a therapeutic response that most commonly required administration of insulin for elevated serum glucose in 17 of 197 occasions in five diabetic PTs. On three occasions potassium was removed from intravenous fluids. Five of 275 (1.8%) low calcium values were treated in five patients. Potassium was replaced in 17 of 32 occasions in 14 patients where it was low. In this group of PTs, PO serum potassium, hemoglobin levels, and serum glucose in diabetics were the only values important in making therapeutic decisions. If laboratory studies can be streamlined into only those necessary, substantial savings in health care will be seen without sacrificing quality medical care.

Tradition Versus Value: Is There Utility in Protocolized Postoperative Laboratory Testing After Elective Colorectal Surgery?

“…It is possible these abnormal values are simply stress hyperglycemia secondary to undergoing an abdominal operation. Additionally, in the current study, and the study done by Skendaris, 6 intervention for hyperglycemia was rare, which again indicates care that is not cost-effective. A recent study of patients undergoing joint arthroplasty that included patients with a diagnosis of diabetes found, as would be expected, that a preoperative diagnosis of diabetes was the strongest risk factor for an abnormal postoperative glucose 17 .…”

“…In 1999, Skenderis et al published their results examining the utility of routine perioperative serum laboratories in a cohort of 105 patients undergoing surgery for colorectal adenocarcinoma. They found that only 1.4% of all postoperative lab tests required an intervention, and they concluded that postoperative laboratory testing should be “streamlined to only those that are necessary, such as postoperative potassium and hemoglobin.” 6 However, it is not clear whether this practice was widely adopted and how it applies in the ERAS era. Despite intense interest in reducing costs in healthcare over the last two decades, this issue had remained largely unstudied until recently, when studies on the utility of routine serum laboratory tests after pelvic reconstructive surgery, 14 spine fusion, 15 and joint arthroplasty 16–18 were published.…”

Perioperative Laboratory Abnormalities in Gynecologic Oncology Surgical Patients

“…The investigators found that, although minor laboratory abnormalities were common postoperatively (12%–67% depending on the test), only a very small subset (0.03%–5.1% depending on the test) triggered an intervention. 16 Overall, those authors reported that serum potassium, hemoglobin, and serum glucose in patients with diabetes were the only values that led to therapeutic decisions. 16 …”

“… 16 Overall, those authors reported that serum potassium, hemoglobin, and serum glucose in patients with diabetes were the only values that led to therapeutic decisions. 16 …”

Role of Hematologic Laboratory Studies in the Postoperative Management of Patients Undergoing Anterior Cervical Diskectomy and Fusion

“…Ransom et al 13 examined the usefulness of type and screening in women undergoing Cesarean section and found that most transfusions were related to identifiable risk factors. Skenderis et al 14 examined the usefulness of routine postoperative testing in patients undergoing resection for adenocarcinoma of the colon and rectum. Postoperative serum potassium and glucose in addition to hemoglobin measurements were the only values found to affect patient care.…”