Key result
Preoperative haemostasis and ABO blood typing tests were performed in 79.3% of children prior to common surgeries, strongly associated with general anesthesia (OR 7.06; 95% CI 4.94-10.11).
Observational (n=13,018)
Yes
Preoperative haemostasis and ABO blood typing tests are frequently performed in children prior to common non-cardiac surgeries in Japan, potentially representing low-value care given the extremely low rate of bleeding complications.
Answers are grounded in this paper and cite their sources.
May indicate low-value preoperative testing in children; leaves open whether selective strategies can safely reduce use.
OBJECTIVES: To describe the prevalence and factors associated with preoperative haemostasis and ABO blood typing tests for children because these tests might represent low-value care. DESIGN: A retrospective observational study. SETTING: Nationwide insurance claims database in Japan. PARTICIPANTS: Patients aged 1-17 years who underwent common non-cardiac surgeries between April 2012 and March 2018 were included. Patients with high-risk comorbidities for bleeding (n=175) and those with multiple eligible surgeries were excluded (n=2121). MAIN OUTCOME MEASURES: We described the proportions of each preoperative test performed within 60 days before an index surgery, including platelet count, prothrombin time (PT), activated partial thromboplastin time (aPTT) and ABO blood typing tests. We also explored the associations between patient-level and institutional-level factors and any preoperative tests, using multilevel logistic regression analysis. RESULTS: We included 13 018 patients (median (IQR) age, 5.2 (2.9-7.7) years; 8276 (63.6%) boys) from 1499 institutions. The overall proportion of each test was as follows: platelet count, 78.6%; PT, 54.4%; aPTT, 56.4% and ABO blood typing tests, 50.4%. The proportion of patients undergoing any preoperative tests in the overall sample was 79.3%. Multilevel logistic regression analysis indicated that preoperative tests were associated with type of anaesthesia (general anaesthesia: adjusted OR 7.06; 95% CI 4.94 to 10.11), type of surgery (tonsillectomy: adjusted OR 3.45; 95% CI 2.75 to 4.33) and surgical setting (inpatient procedure: adjusted OR 5.41; 95% CI 3.83 to 7.66). There was one postoperative transfusion event (0.008%) in the entire cohort and 37 postoperative reoperation events for surgical bleeding after tonsillectomy (0.90%). CONCLUSIONS: In the largest Japanese cohort reported to date, preoperative haemostasis and ABO blood typing tests were performed in a majority of children prior to common paediatric surgeries. Preoperative tests were associated with anaesthesia, surgical type and surgical setting.
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Yonekura et al. (2019) conducted an observational in Common non-cardiac surgeries (n=13,018). Preoperative haemostasis and ABO blood typing tests was evaluated on Proportion of patients undergoing any preoperative tests within 60 days before an index surgery. Preoperative haemostasis and ABO blood typing tests were performed in 79.3% of children prior to common surgeries, strongly associated with general anesthesia (OR 7.06; 95% CI 4.94-10.11).
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