Key result
Routine pre-operative laboratory testing resulted in 52% of tests being unindicated per NICE guidelines, accounting for 63% of total test costs, with none altering the anaesthetic plan.
Why the study?
Does routine pre-operative testing lead to unindicated tests and increased costs compared to NICE guidelines in patients undergoing elective surgery?
Observational (n=163)
No
Does routine pre-operative testing lead to unindicated tests and increased costs compared to NICE guidelines in patients undergoing elective surgery?
Routine pre-operative testing frequently includes unindicated tests, such as echocardiography and chest X-rays, which significantly increase healthcare costs without altering clinical management.
May reduce unnecessary preoperative testing costs without changing plans; leaves open outcome effects, needing prospective trials.
BACKGROUND AND AIMS: Pre-operative investigations are performed before any surgical intervention under anaesthesia. Many are considered as routine. However, there are no clear guidelines regarding these in India. We aim to look at the relevance of the laboratory investigations ordered routinely and their cost implications compared with the National Institute of Clinical Excellence (NICE) guidelines. METHODS: This prospective study was carried out at a tertiary care hospital. A total of 163 patients scheduled for elective surgical procedures were included in this study. Neither the surgeons nor anaesthesiologists involved in the case were aware of the study. The laboratory investigations of the patients who underwent surgery were noted. All values were categorised as normal or abnormal and they were assessed as indicated or unindicated based on NICE guidelines. RESULTS: One hundred and sixty-three patients were subjected to a total of 984 tests. Forty three patients (26%) were subjected to tests as per NICE guidelines. Of the 984 tests, 515 tests were unindicated (52%). Out of the 515 unindicated tests, 7 (1.3%) were abnormal. None of these seven tests required any intervention or change of anaesthetic plan. The most common unindicated tests done were cardiac echocardiography and chest X-ray (92.5% and 93% respectively). The additional cost incurred towards unindicated tests was 63% of the total cost for the tests. CONCLUSION: Pre-operative laboratory investigations add to cost significantly. Patient premorbid conditions and surgical grade should guide the clinician to request for the relevant laboratory tests.
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Keshavan et al. (2016) conducted an observational in Elective surgical procedures (n=163). Routine pre-operative laboratory investigations vs. NICE guidelines was evaluated on Proportion of unindicated tests based on NICE guidelines. Routine pre-operative laboratory testing resulted in 52% of tests being unindicated per NICE guidelines, accounting for 63% of total test costs, with none altering the anaesthetic plan.
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