Systematic preoperative tests prescription in elective surgery: it’s high time to appraise!

##plugins.themes.academic_pro.article.sidebar##

Published Jul 9, 2022
Download
pdf
Vol. 100 No. 7 (2022): Issue Jul 2022

##plugins.themes.academic_pro.article.main##

Becem Trabelsi
Ibtissem Ben Taleb
Mehdi Trifa
Mechaal Ben Ali

Abstract

Background: The prescription of preoperative complementary tests aims to decrease morbidity and mortality associated to the perioperative period.
Aim: To assess the practice and the financial cost of the systematic prescription of preoperative tests.

Methods: This was a retrospective study including all patients older than three years, scheduled for elective surgery from November 2018 to
January 2019. Two attendings analyzed the data collected during the pre-anesthetic assessment and evaluated the usefulness of the ordered
preoperative tests. The overall cost of prescribed preoperative tests and the cost generated by inappropriate prescriptions were also estimated.

Results: This study included 1006 patients. The average age was 46.9 ± 22.05 years old. Five hundred and twenty three of them (51.98%) have
no medical history. Among the planned procedures, 6.46% had an intermediate or major bleeding risk. Preoperative prescriptions were ordered
by surgeons in 99% of cases. Prescriptions were justifiable in only 9.42% of cases. Abnormal findings were noted in 4.98% of the patients. The
total cost was almost 80992 Dinars (≈ 24543 €). Complying the guidelines would save 70245 Dinars (≈ 21286 €) during the three months` study.

Conclusion: The routine prescription of preoperative complementary tests results in a significant additional economic cost. Developing national
guidelines would change this attitude of unnecessary prescription.

Keywords:

surgical clearance - elective surgical procedure - costs and cost analysis - inappropriate prescribing

##plugins.themes.academic_pro.article.details##

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

References

  1. Glance LG, Lustik SJ, Hannan EL, Osler TM, Mukamel DB, Qian F, et al. The surgical mortality probability model: derivation and validation of a simple risk prediction rule for noncardiac surgery. Ann Surg. 2012;255(4):696-702.
  2. Agence Nationale d’Accréditation et d’Évaluation en Santé. Les examens préopératoires systématiques. Paris : ANAES; 1998.
  3. Molliex S, Pierre S, Bléry C, Marret E, Beloeil H. Examens préinterventionnels systématiques. Annales Françaises d’Anesthésie et de Réanimation. sept 2012;31(9):752-63.
  4. Practice Advisory for Preanesthesia Evaluation. An Updated Report by the American Society of Anesthesiologists Task Force on Preanesthesia Evaluation. Chicago : ASA; 2012.
  5. National Institute for Health and Care Excellence. Preoperative Tests: routine preoperative tests for elective surgery. London : NICE; 2016.
  6. Sui W, Theofanides MC, Matulay JT, James MB, Onyeji IC, RoyChoudhury A, et al. Utilization of Preoperative Laboratory Testing for Low-risk, Ambulatory
  7. Soares D de S, Brandão RRM, Mourão MRN, Azevedo VLF de, Figueiredo AV, Trindade ES. Relevance of routine testing in low-risk patients undergoing minor and medium surgical procedures. Braz J Anesthesiol. 2013;63(2):197-201.
  8. Souissi AB, Rebai A, Kamoun S, Haddad F, Sboui M, Mebazaa MS. Prescription des examens complémentaires préopératoires : audit des pratiques en Tunisie. Anesthésie & Réanimation. 2015;1(1):174.
  9. Srivastava U, Kumar A. Role of routine laboratory investigations in preoperative evaluation. J Anaesth Clin Pharmacol. 2011;27(2):174.
  10. Kansagra AJ, Stefan MS. Preoperative Anemia. Anesthesiol Clin N A. 2016;34(1):127-41.
  11. Bernard R, Benhamou D, Beloeil H. Prescription des examens biologiques préopératoires : audit des pratiques dans un hôpital universitaire et mise en place de recommandations locales. Ann Fr d’Anesth. 2010;29(12):868-73.
  12. Société de Pathologie Infectieuse de Langue Française. Révision des recommandations de bonne pratique pour la prise en charge et la prévention des Infections Urinaires Associées aux Soins (IUAS) de l’adulte. Paris : SPILF; 2015.
  13. Czoski-Murray C, Lloyd Jones M, McCabe C, Claxton K, Oluboyede Y, Roberts J, et al. What is the value of routinely testing full blood count, electrolytes and urea, and pulmonary function tests before elective surgery in patients with no apparent clinical indication and in subgroups of patients with common comorbidities: a systematic review of the clinical and cost-effective literature. Health Technol Assess. 2012;16(50),1-159.
  14. Bock M, Johansson T, Fritsch G, Flamm M, Hansbauer B, Mann E, et al. The impact of preoperative testing for blood glucose concentration and haemoglobin A1c on mortality, changes in management and complications in noncardiac elective surgery: a systematic review. Eur J Anaesthesiol. 2015;32(3):152-9.
  15. Deffarges C, Marty J, Sacuto T, Desmonts JM. Evaluation de la qualité d’interprétation de l’électrocardiogramme préopératoire par les médecins anesthésistes. Ann Fr Anesth. 1990; 9(5):403-7.
  16. Preoperative chest radiology. National study by the Royal College of Radiologists. Lancet. 1979;2(3):83-6.
  17. Nze PU, Njike C. Is routine preoperative chest X-ray indicated in elderly patients undergoing elective surgery? Niger J Med. 2008;17(2):150-2.
  18. Munro J, Booth A, Nicholl J. Routine preoperative testing: a systematic review of the evidence. Health Technol Assess. 1997;1(12);1-62.
  19. Zaher G, Al-Noury K. The Value of Routine Preoperative Testing in the Prediction of Operative Hemorrhage in Adenotonsillectomy. Indian J Otolaryngol Head Neck Surg. 2014;66(1):30-6.
  20. Thanh NX, Rashiq S, Jonsson E. Routine preoperative electrocardiogram and chest x-ray prior to elective surgery in Alberta, Canada. Can J Anaesth. 2010; 57(2):127-33.
  21. Nash GF, Cunnick GH, Allen S, Cook C, Turner LF. Pre-operative electrocardiograph examination. Ann R Coll Surg Engl. 2001;83(6):381-2.
  22. Yuan H, Chung F, Wong D, Edward R. Current preoperative testing practices in ambulatory surgery are widely disparate: a survey of CAS members. Can J Anesth. 2005;52(7):675-9.
  23. Narayanan R, Habib Md Reazaul K, Avinash P, Sarasa Kumar S, Mridul D, Anilkumar N. Prevalence and impact of abnormal routine pre-operative test results among elective surgical patients with or without co-morbidity: An observational comparative study. Niger Med J. 2014;25(4);121-5.
  24. Onuoha OC, Hatch MB, Miano TA, Fleisher LA. The incidence of unindicated preoperative testing in a tertiary academic ambulatory center: a retrospective cohort study. Perioper Med. 2015;4(14):1-8.
  25. El Baz B. Entre la pratique et les recommandations: Quel impact économique de la prescription des examens pré-interventionnels lors de la consultation d’anesthésie [thèse].Médecine : Marrakech;2016.136p.
  26. Yazıcı H, Daşkaya H, Doğan S, Haberal İ, Çiftçi T. Patient specific or routine preoperative workup in septoplasty: which one is cost-effective? Eur Arch Otorhinolaryngol. 2014;271(2):305-9.
  27. Karim HMR, Prakash A, Sahoo SK, Narayan A, Vijayan V. Abnormal routine pre-operative test results and their impact on anaesthetic management: An observational study. Indian J of Anaesth. 2018;62(1):23.
  28. Blery C, Szatan M, Fourgeaux B, Charpak Y, Darne B, Chastang Cl. Evaluation of a protocol for selective ordering of preoperative tests. Lancet. 1986;327(8473):139-41.
  29. Benarroch-Gampel J, Sheffield KM, Duncan CB, Brown KM, Han Y, Townsend CM. Preoperative laboratory testing in patients undergoing Elective, Low-Risk Ambulatory Surgery. Ann Surg. 2012;256(3):518-28
  30. Jokelainen J, Ismail S, Kylänpää L, Udd M, Mustonen H, Lindström O, et al. Effect and predictive value of routine preoperative laboratory testing for endoscopic retrograde cholangiopancreatography. Scand J Surg. 2020;109(2):115-20
  31. Kannaujia AK, Gupta A, Verma S, Srivastava U, Haldar R, Jasuja S. Importance of routine laboratory investigations before elective surgery. Discoveries. 2020;8(3):114.
  32. Burnett TL, Junn J, Kolenic GE, Christen C, Johnston CM, Reynolds RK. Perioperative laboratory abnormalities in gynecologic oncology surgical patients. J Gynecol Surg. 2016;32(2):111-8.
  33. Louie RJ, Tonneson JE, Gowarty M, Goodney PP, Barth RJ, Rosenkranz KM. Complete blood counts, liver function tests, and chest x-rays as routine screening in early-stage breast cancer: value added or just cost?. Breast Cancer Res Treat. 2015;154(1):99-103.