Key result
Routine preoperative laboratory tests yielded unexpected pathological results in only 2.1% of tests, resulting in zero changes to anaesthetic management.
Why the study?
Do routine laboratory preoperative tests yield unexpected pathological results that change anaesthetic management in outpatients undergoing surgery?
Observational (n=1,129)
No
Do routine laboratory preoperative tests yield unexpected pathological results that change anaesthetic management in outpatients undergoing surgery?
Routine preoperative laboratory testing rarely yields unexpected pathological results and does not alter anaesthetic management, highlighting the inefficiency of non-selective testing.
Answers are grounded in this paper and cite their sources.
Routine POTs rarely alter management; supports selective testing guided by history and prior results over routine panels.
INTRODUCTION: The usefulness and cost-effectiveness of routine laboratory preoperative tests (POTs) have been challenged recently. In fact, the American Society of Anesthesiologists (ASA) Task Force has stated that test results obtained from the medical record within 6 months of surgery generally are mostly acceptable. The aim of our study was to evaluate the degree of utility of POTs and their clinical benefit based on this recommendation. MATERIAL AND METHODS: We studied retrospectively every routine POT request from 8 randomly selected weeks in 2016. Every POT contained glucose, creatinine, haemoglobin and coagulation tests (PT-INR). Each pathological result for these tests was registered and classified as "expected" (if previous pathological result within 6 months existed for that test) or "unexpected" (if previous pathological result within 6 months did not exist for that test). Results of ASA physical status classification (a system for assessing the fitness of patients before surgery) and changes in patient management after POTs were retrieved from medical history as well. RESULTS: A total of 4516 tests (from 1129 patients) were analysed and 498 results were found pathological (11%). Of these, 403 were expected (8.9%) and 95 unexpected (2.1%). There was not any change in anaesthetic management for any patient due to these findings. CONCLUSIONS: Routine POTs are an inefficient and low-value service. POTs have to be always ordered selectively after a previous consideration of specific information obtained from several sources (medical records, interviews, examinations, type of surgery) and only if the information obtained will result in changes in the management of the patient.
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Rodríguez–Borja et al. (2017) conducted an observational in Outpatients undergoing surgery (n=1,129). Routine laboratory preoperative tests was evaluated on Unexpected pathological test results. Routine preoperative laboratory tests yielded unexpected pathological results in only 2.1% of tests, resulting in zero changes to anaesthetic management.
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