Key result
Routine pre-operative tests were frequently ordered against guidelines prior to elective cholecystectomy, including CBC in 77% of patients, resulting in $16,021 of excess costs.
Why the study?
Previous studies highlighted the burden of routine pre-operative test ordering, but compliance with guidelines and associated costs prior to elective cholecystectomy remained unexamined in this setting.
Does routine pre-operative testing prior to elective cholecystectomy align with guidelines and what is the associated cost?
Cross-Sectional (n=382)
No
Does routine pre-operative testing prior to elective cholecystectomy align with guidelines and what is the associated cost?
Strict adherence to guidelines for routine preoperative test ordering before elective surgeries can significantly reduce healthcare costs without increasing post-operative complications.
Answers are grounded in this paper and cite their sources.
Guideline non-adherence for pre-op tests may inflate costs; leaves open whether targeted interventions improve compliance in elective surgery.
Background: Previous studies stressed on the burden raised by routine pre-operative test ordering, which should be based on the assessment of patient physical status. In a tertiary hospital in Jordan, we aim to study the compliance with guidelines regarding pre-operative routine testing prior to an elective surgery, cholecystectomy, and calculate the estimated cost from non-compliance with the guidelines.Methods: We included laparoscopic cholecystectomy (through ICD-9 code) to represent an elective surgery. For each surgery done from the period 1/1/2016 to 31/12/2016, data regarding preoperative investigations, admission history note, operative and discharge note were obtained. Tests that are considered routine investigations are Complete blood count (CBC), kidney function tests (KFT), electrolytes, chest X-ray, electrocardiogram, coagulation studies, and urine-analysis. We classified patients who underwent cholecystectomy according to the latest version of the American Society of Anesthesiologists (ASA) physical status system to assess the need for routine tests, then we calculated the number and cost of excess tests.Results: A total 382 routine, non-emergent laparoscopic cholecystectomy surgeries were performed. 319 (83.5%) of patients were classified as ASA-1, 60 (15.7%) were classified as ASA-2, and only 3 (0.8%) were classified as ASA-3. Age was a significant determinant in obtaining chest X-ray ordering and findings (p< 0.001) and electrolytes ordering and findings (p= 0.001). Total routine tests cost for elective cholecystectomy during 2016 was 16,021$. Regarding operative compilations, only 14 (3.7%) complication occurred, all of which were bleeding related.Conclusion: Oversighting routine preoperative test ordering before elective cholecystectomy will significantly reduce the cost without increasing post-operative complications.
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Samara et al. (2020) conducted a cross-sectional in Elective laparoscopic cholecystectomy (n=382). Routine pre-operative testing vs. Guideline-indicated testing was evaluated on Proportion of pre-operative tests ordered without clinical indication according to ASA and NICE guidelines. Routine pre-operative tests were frequently ordered against guidelines prior to elective cholecystectomy, including CBC in 77% of patients, resulting in $16,021 of excess costs.
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