Preoperative laboratory testing was performed in 63.8% of patients undergoing elective hernia repair but was not associated with postoperative complications (overall rate 0.3%).
Observational (n=73,596)
Yes
Does preoperative laboratory testing reduce postoperative complications in patients undergoing elective hernia repair?
Preoperative laboratory testing is frequently overused in low-risk ambulatory surgery and does not predict or prevent postoperative complications, supporting guidelines against routine testing.
BACKGROUND: Routine preoperative laboratory testing for ambulatory surgery is not recommended. METHODS: Patients who underwent elective hernia repair (N = 73,596) were identified from the National Surgical Quality Improvement Program (NSQIP) database (2005-2010). Patterns of preoperative testing were examined. Multivariate analyses were used to identify factors associated with testing and postoperative complications. RESULTS: A total of 46,977 (63.8%) patients underwent testing, with at least one abnormal test recorded in 61.6% of patients. In patients with no NSQIP comorbidities (N = 25,149) and no clear indication for testing, 54% received at least one test. In addition, 15.3% of tested patients underwent laboratory testing the day of the operation. In this group, surgery was done despite abnormal results in 61.6% of same day tests. In multivariate analyses, testing was associated with older age, ASA (American Society of Anesthesiologists) class >1, hypertension, ascites, bleeding disorders, systemic steroids, and laparoscopic procedures. Major complications (reintubation, pulmonary embolus, stroke, renal failure, coma, cardiac arrest, myocardial infarction, septic shock, bleeding, or death) occurred in 0.3% of patients. After adjusting for patient and procedure characteristics, neither testing nor abnormal results were associated with postoperative complications. CONCLUSIONS: Preoperative testing is overused in patients undergoing low-risk, ambulatory surgery. Neither testing nor abnormal results were associated with postoperative outcomes. On the basis of high rates of testing in healthy patients, physician and/or facility preference and not only patient condition currently dictate use. Involvement from surgical societies is necessary to establish guidelines for preoperative testing.
Benarroch‐Gampel et al. (Tue,) conducted a observational in Elective, low-risk ambulatory surgery (hernia repair) (n=73,596). Preoperative laboratory testing vs. No testing was evaluated on Postoperative complications. Preoperative laboratory testing was performed in 63.8% of patients undergoing elective hernia repair but was not associated with postoperative complications (overall rate 0.3%).