Key result
Compliance with institutional preoperative testing guidelines for ASA I patients undergoing elective surgery was only 12.1% (95% CI, 10.5-13.9).
Observational (n=1,496)
No
Compliance with preoperative testing guidelines for low-risk surgical patients is remarkably low, leading to significant unnecessary healthcare expenditure.
Persistent low compliance with preoperative testing guidelines in low-risk patients may incur excess costs; leaves open effective strategies to improve adherence.
BACKGROUND: Few investigations preoperatively are important for low-risk patients. This study was designed to determine the level of compliance with preoperative investigation guidelines for ASA I patients undergoing elective surgery. Secondary objectives included the following: to identify common inappropriate investigations, to evaluate the impact of abnormal testing on patient management, to determine factors affecting noncompliant tests, and to estimate unnecessary expenditure. METHODS: This retrospective study was conducted on adult patients over a one-year period. The institute's guidelines recommend tests according to the patients' age groups: a complete blood count (CBC) for those patients aged 18-45; CBC, chest radiograph (CXR) and electrocardiography (ECG) for those aged 46-60; and CBC, CXR, ECG, electrolytes, blood glucose, blood urea nitrogen (BUN), and creatinine (Cr) for patients aged 61-65. RESULTS: The medical records of 1,496 patients were reviewed. Compliant testing was found in only 12.1% (95% CI, 10.5-13.9). BUN and Cr testings were the most frequently overprescribed tests. Overinvestigations tended to be performed on major surgery and younger patients. Overall, overinvestigation incurred an estimated cost of US 200,000 dollars during the study period. CONCLUSIONS: The need to utilize the institution's preoperative guidelines should be emphasized in order to decrease unnecessary testing and the consequential financial burden.
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Siriussawakul et al. (2013) conducted an observational in ASA I patients undergoing elective surgery (n=1,496). Institutional preoperative testing guidelines was evaluated on Compliance with preoperative investigation guidelines (95% CI 10.5-13.9). Compliance with institutional preoperative testing guidelines for ASA I patients undergoing elective surgery was only 12.1% (95% CI, 10.5-13.9).
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