Key result
Routine preoperative testing in patients aged ≥60 years yielded at least one abnormal result in 69.06% of patients, but only 11.20% of abnormalities impacted anesthetic management (NNI 255).
Why the study?
Do routine preoperative investigations impact perioperative anesthetic management in patients aged 60 years and older?
Observational (n=181)
Do routine preoperative investigations impact perioperative anesthetic management in patients aged 60 years and older?
Routine preoperative testing in patients aged 60 and older frequently yields abnormal results but rarely alters anesthetic management, often causing unnecessary delays.
Answers are grounded in this paper and cite their sources.
May not justify routine preoperative testing in older adults; leaves open optimal selective strategies for future trials.
Background and Aim: Physiology of the human body changes with aging making physicians more inclined toward the use of routine preoperative investigations in the elderly to detect hidden abnormalities. The present study was aimed to assess the prevalence of abnormal test results and their impact on anesthetic management among patients aged 60 years or more. Methods: This observational study was conducted during December 2016 to April 2017. Data were collected by prospectively screening the files of the patients attending preanesthetic evaluation clinic (PAEC). Demographic parameters, physical status, surgery grade, normal and different abnormal test results, and their impacts were noted. Data were expressed in absolute numbers, percentage scale, and number needed to investigate (NNI). Central tendencies and dispersions were calculated using INSTAT software. Results: Data from file of 181 patients (mean + standard deviation age 66.69 + 5.89 years; 82 [45.30%] female) were collected. The median American Society of Anesthesiologists physical status was II and 59.67% underwent National Institute of Clinical and Health Excellence Grade 1 surgery. Entire patient attended PAEC with routine investigations done; 125 (69.06%) had at least one abnormality. Out of total 1275 tests done, 241 (18.90%) results were abnormal. Only 27 (11.20%) abnormality had an impact; 21 (77.78%) did not alter preoperative/anesthetic management but led to further testing, unnecessary consultation, and mean 3.84 days delay. The NNI for detecting one significant impact was 255. Conclusion: Majority of the patients aged 60 years or more were having at least one abnormal test results in routine preoperative tests but had minimal impacts in perioperative anesthetic management. It caused unnecessary further testing, consultation, and delay. Age per se should not be a criterion for ordering routine preoperative testing. The clinical trial registration number was CTRI/2018/01/011235.
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Karim et al. (2018) conducted an observational in Patients requiring preanesthetic evaluation (n=181). Routine preoperative testing was evaluated on Prevalence of abnormal test results and their impact on anesthetic management (NNI 255). Routine preoperative testing in patients aged ≥60 years yielded at least one abnormal result in 69.06% of patients, but only 11.20% of abnormalities impacted anesthetic management (NNI 255).
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