The clinical utility of routine preoperative blood testing in paediatric neurosurgery: a retrospective clinical study of preoperative practices

PURPOSE: Routine preoperative blood testing in healthy children is common, but evidence suggests it has minimal impact on perioperative management. This retrospective study evaluated testing practices, testing duplications, costs and clinical utility in elective paediatric neurosurgery procedures in a paediatric tertiary centre. METHODS: All elective paediatric neurosurgical procedures in children from January 2022 to June 2025 were reviewed. Data collected included demographics, procedure type and prior and preoperative blood testing within 30 days of the operation, test results, sample quality, clinical impact and direct costs. Descriptive statistics were performed. RESULTS: 226 procedures for a total of 198 patients were analysed. The mean age was 10.5 and the majority of patients were male (58%). In total, 202 preoperative blood tests (89%) were performed. Abnormal results occurred in 120 cases (59%), but none altered surgical or anaesthetic management. Prior testing within six months was available for 77 children and 67 underwent repeat testing despite previously normal results. Additionally, 24 children had no preoperative blood tests. The estimated cost saving for this study was £578 for 3 years, and adopting a selective testing strategy could save over £1000. CONCLUSION: Routine preoperative blood testing in healthy children has minimal impact on perioperative management, often duplicates prior tests and may cause patient discomfort. A selective, risk- and procedure-based testing strategy, particularly for high-risk groups such as intracranial tumours, can enhance patient experience and reduce costs without compromising safety.