Routine preoperative laboratory investigations in otherwise healthy patients are of little clinical value, rarely alter anesthetic management, and increase costs, supporting a shift toward selective testing.
Does routine preoperative laboratory testing improve outcomes or change management compared to selective testing in patients undergoing elective surgery?
Routine preoperative laboratory testing in healthy patients is of low yield and high cost, supporting a shift toward selective testing guided by clinical history and physical examination.
Traditionally, routine investigations prior to surgery are considered an important element of preanesthetic evaluation to determine the fitness for anesthesia and surgery. During past few decades this practice has been a subject of close scrutiny due to low yield and high aggregate cost. Performing routine screening tests in patients who are otherwise healthy is invariably of little value in detecting diseases and in changing the anesthetic management or outcome. Thorough history and investigation of positive answers by the clinicians, combined with physical examination of patient represents the best method for screening diseases followed by few selective tests as guided by patient's health condition, invasiveness of planned surgery and potential for blood loss. A large number of investigations which are costly to pursue often detect minor abnormalities of no clinical relevance, may be risky to patients, cause unnecessary delay or cancellation of surgery, and increase medico-legal liability. An approach of selective testing reduces cost without sacrificing safety or quality of surgical care.
Srivastava et al. (Sat,) conducted a review in Preoperative evaluation. Routine preoperative laboratory investigations vs. Selective testing based on clinical evaluation was evaluated. Routine preoperative laboratory investigations in otherwise healthy patients are of little clinical value, rarely alter anesthetic management, and increase costs, supporting a shift toward selective testing.