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Jonker P, van den Heuvel S, Hoeks S, Heijkoop È, Stolker RJ, Korstanje JW. Alternatives to the in-person anaesthetist-led preoperative assessment in adults undergoing low-risk or intermediate-risk surgery: A scoping review. Eur J Anaesthesiol 2023; 40:343-355. [PMID: 36876738 PMCID: PMC10097490 DOI: 10.1097/eja.0000000000001815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
BACKGROUND The design of the optimal preoperative evaluation is a much debated topic, with the anaesthetist-led in-person evaluation being most widely used. This approach is possibly leading to overuse of a valuable resource, especially in low-risk patients. Without compromising patient safety, we hypothesised that not all patients would require this type of elaborate evaluation. OBJECTIVE The current scoping review aims to critically appraise the range and nature of the existing literature investigating alternatives to the anaesthetist-led preoperative evaluation and their impact on outcomes, to inform future knowledge translation and ultimately improve perioperative clinical practice. DESIGN A scoping review of the available literature. DATA SOURCES Embase, Medline, Web-of-Science, Cochrane Library and Google Scholar. No date restriction was used. ELIGIBILITY CRITERIA Studies in patients scheduled for elective low-risk or intermediate-risk surgery, which compared anaesthetist-led in-person preoperative evaluation with non-anaesthetist-led preoperative evaluation or no outpatient evaluation. The focus was on outcomes, including surgical cancellation, perioperative complications, patient satisfaction and costs. RESULTS Twenty-six studies with a total of 361 719 patients were included, reporting on various interventions: telephone evaluation, telemedicine evaluation, evaluation by questionnaire, surgeon-led evaluation, nurse-led evaluation, other types of evaluation and no evaluation up to the day of surgery. Most studies were conducted in the United States and were either pre/post or one group post-test-only studies, with only two randomised controlled trials. Studies differed largely in outcome measures and were of moderate quality overall. CONCLUSIONS A number of alternatives to the anaesthetists-led in-person preoperative evaluation have already been researched: that is telephone evaluation, telemedicine evaluation, evaluation by questionnaire and nurse-led evaluation. However, more high-quality research is needed to assess viability in terms of intraoperative or early postoperative complications, surgical cancellation, costs, and patient satisfaction in the form of Patient-Reported Outcome Measures and Patient-Reported Experience Measures.
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Affiliation(s)
- Philip Jonker
- From the Department of Anaesthesia, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands (PJ, SvdH, SH, EH, RJS, JWK)
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Pluta MP, Dziech M, Klocek T, Szczepańska AJ, Krzych ŁJ. Diagnostic Accuracy of Platelet-Derived Parameters in Prognostication in Neurosurgery. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127115. [PMID: 35742363 PMCID: PMC9222923 DOI: 10.3390/ijerph19127115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 06/07/2022] [Accepted: 06/08/2022] [Indexed: 12/10/2022]
Abstract
Introduction. Platelets (PLT) are key mediators in thrombotic and inflammatory processes. Their activity increases with size, so the mean platelet volume (MPV) can be a potential predictor of perioperative complications. The aim of the study was to assess the suitability of platelet parameters in predicting the risk of hospital death in neurosurgery. Methods. Retrospective observation covered 452 patients undergoing surgery in the period March 2018−August 2018. High-risk patients accounted for 44% (i.e., ASA-PS class III+) and 9% (i.e., ≥1 Shoemaker criterion), respectively, and 14% of procedures were performed in the urgent mode. The preoperative platelet parameters that were assessed and analysed were: total platelet count (PLT), mean platelet volume (MPV), plateletcrit (PCT) and platelet distribution width (PDW). The end point of the study was a hospital death. Results. Before discharge from the hospital, 13 patients died. The medians (IQR) PLT, MPV PDW and PCT were, respectively: 230 × 106 L−1 (182−279); 9.2 fL (8.3−10.1); 14% (12.5−16.3); and 21% (17−26). PLT, PCT and PDW were not useful in the risk assessment. MPV was lower in patients who died (9.3 vs. 8.3 fL, p < 0.01) and predicted death occurred in 76% (AUC = 0.76, 95%CI 0.72−0.80, p < 0.01). Further, after adjustment for confounders, MPV remained a significant predictor of in-hospital death (logOR[MPV] = 0.31, AUC = 0.94, 95%CI 0.92−0.96, p = 0.02). Conclusion. The reduction in the average volume of platelets is associated with a worse prognosis in neurosurgical patients.
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Affiliation(s)
- Michał P. Pluta
- Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40752 Katowice, Poland; (A.J.S.); (Ł.J.K.)
- Correspondence: ; Tel.: +48-32-7894201
| | - Magdalena Dziech
- Students’ Scientific Society, Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40752 Katowice, Poland; (M.D.); (T.K.)
| | - Tomasz Klocek
- Students’ Scientific Society, Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40752 Katowice, Poland; (M.D.); (T.K.)
| | - Anna J. Szczepańska
- Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40752 Katowice, Poland; (A.J.S.); (Ł.J.K.)
| | - Łukasz J. Krzych
- Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40752 Katowice, Poland; (A.J.S.); (Ł.J.K.)
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Umesh G, Bhaskar SB, Harsoor SS, Dongare P, Garg R, Kannan S, Ali Z, Nair A, Bhure A, Grewal A, Singh B, Rao D, Divatia J, Sinha M, Kumar M, Joshi M, Shastri N, Malhotra N, Saikia P, Rajesh MC, Das S, Ghosh S, Subramanyam M, Tantry T, Mangal V, Keshavan V. Preoperative Investigations: Practice Guidelines from the Indian Society of Anaesthesiologists. Indian J Anaesth 2022; 66:319-343. [PMID: 35782661 PMCID: PMC9241185 DOI: 10.4103/ija.ija_335_22] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/01/2022] [Accepted: 05/06/2022] [Indexed: 11/04/2022] Open
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Hasan O, Fahad S, Mustafa M, Hashmi P, Noordin S. Does more testing in routine preoperative evaluation benefit the orthopedic patient? Case control study from a resource-constrained setting. Ann Med Surg (Lond) 2021; 66:102439. [PMID: 34136212 PMCID: PMC8181773 DOI: 10.1016/j.amsu.2021.102439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/21/2021] [Accepted: 05/23/2021] [Indexed: 11/30/2022] Open
Abstract
Background Routine preoperative tests in healthy patients not only cause extra anxiety, but may delay treatment without influencing surgical plan. This has worse impact in resource-constrained settings where fee for service rather than health insurance is the usual norm. Investigators aim to determine if “routine” pre-operative tests are justified in healthy orthopedic patients. Methods We conducted a non-commercialized, non-funded matched case control study in tertiary care university hospital and a level-1 trauma centre for healthy patients (ASA-1&2) admitted from January 2014–December 2016 for elective orthopedic intermediate and major procedures. Cases (patient who had a change in his/her surgical plan after admission) and controls were selected independently of the exposure of interest then matched randomly to cases on age, gender and procedure type. Primary exposure was the routine preoperative lab tests, as defined by the American Society of Anesthesiologist, which included 13 blood tests. Analysis was done using Principle Component Analysis and Conditional logistic regression at univariate and multivariable levels reporting matched adjusted Odds Ratios. The data was reported in line with STROCSS criteria. Results Overall, 7610 preoperative tests were done for 670 patients with 62% men among cases and 53% men among controls with mean age of 49.9±22.5 years and 41.1±23.0 years, respectively. There were 1076 (14%) abnormal result that influenced surgical plan in 0.96% cases only. Matched adjusted OR with 95% confidence interval of primary exposure was insignificant. Conclusion Routine preoperative tests were superfluous and did not influence the surgical plan when adjusted for other variables in the model as well as after matching on potential confounders. This study would be amongst first steps to move towards an evidence based surgical practice for preoperative evaluation. The “routine” pre-operative tests in healthy orthopaedic patients undergoing intermediate/major surgery are not justified. Surgical plan was influenced in <1% of ASA-I & ASA-II elective orthopedic patients. Blood tests were not associated with change in surgical plan. Surgeons should be sensitized to reconsider this practice particularly with limited resources.
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Affiliation(s)
- Obada Hasan
- Orthopaedic Oncology & Reconstruction Fellow, Department of Orthopaedics and Rehabilitation University of Iowa, Pakistan
| | - Shah Fahad
- Resident in Orthopedic Surgery, Department of Surgery, Section of Orthopedics, The Aga Khan University Hospital, Pakistan
- Corresponding author. Department of Surgery, Section of Orthopedics, The Aga Khan University Hospital, Pakistan.
| | | | - Pervaiz Hashmi
- Department of Surgery, Section of Orthopedics, The Aga Khan University Hospital, Pakistan
| | - Shahryar Noordin
- Department of Surgery, Section of Orthopedics, The Aga Khan University Hospital, Pakistan
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Gandhi A, Görlinger K, Nair SC, Kapoor PM, Trikha A, Mehta Y, Handoo A, Karlekar A, Kotwal J, John J, Apte S, Vohra V, Gupta G, Tiwari AK, Rani A, Singh SA. Patient blood management in India - Review of current practices and feasibility of applying appropriate standard of care guidelines. A position paper by an interdisciplinary expert group. J Anaesthesiol Clin Pharmacol 2021; 37:3-13. [PMID: 34103816 PMCID: PMC8174427 DOI: 10.4103/joacp.joacp_410_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 09/09/2020] [Accepted: 10/04/2020] [Indexed: 01/09/2023] Open
Abstract
In a developing country like India, with limited resources and access to healthcare facilities, dealing with massive hemorrhage is a major challenge. This challenge gets compounded by pre-existing anemia, hemostatic disorders, and logistic issues of timely transfer of such patients from peripheral hospitals to centers with adequate resources and management expertise. Despite the awareness amongst healthcare providers regarding management modalities of bleeding patients, no uniform Patient Blood Management (PBM) or perioperative bleeding management protocols have been implemented in India, yet. In light of this, an interdisciplinary expert group came together, comprising of experts working in transfusion medicine, hematology, obstetrics, anesthesiology and intensive care, to review current practices in management of bleeding in Indian healthcare institutions and evaluating the feasibility of implementing uniform PBM guidelines. The specific intent was to perform a gap analysis between the ideal and the current status in terms of practices and resources. The expert group identified interdisciplinary education in PBM and bleeding management, bleeding history, viscoelastic and platelet function testing, and the implementation of validated, setting-specific bleeding management protocols (algorithms) as important tools in PBM and perioperative bleeding management. Here, trauma, major surgery, postpartum hemorrhage, cardiac and liver surgery are the most common clinical settings associated with massive blood loss. Accordingly, PBM should be implemented as a multidisciplinary and practically applicable concept in India in a timely manner in order to optimize the use the precious resource blood and to increase patients' safety.
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Affiliation(s)
- Ajay Gandhi
- Head - Clinical Affairs, Instrumentation Laboratory India Pvt Ltd, New Delhi, India
| | - Klaus Görlinger
- Medical Director, TEM Innovations/PBM Instrumentation Laboratory, Munich, Germany
| | - Sukesh C Nair
- Department of Transfusion Medicine and Immunohematology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Poonam M Kapoor
- Department of Cardiac Anaesthesia, All India Institute of Medical Sciences, New Delhi, India
| | - Anjan Trikha
- Department of Anaesthesiology, Pain Medicine and Critical Care, In Charge Trauma Intensive Care Unit and Trauma Anaesthesia, JPN Apex Trauma Centre, New Delhi, India
| | - Yatin Mehta
- Department of Cardiac Anaesthesia, Medanta the Medicity, Gurugram, Haryana, India
| | - Anil Handoo
- Department of Laboratory Medicine, BLK Superspeciality Hospital, New Delhi, India
| | - Anil Karlekar
- Department of Cardiac Anaesthesia, Fortis Escorts Heart Institute, New Delhi, India
| | - Jyoti Kotwal
- Department of Haematology, Sir Gangaram Hospital, New Delhi, India
| | - Joseph John
- Department of Haematology and Bone Marrow Transplant, Christian Medical College, Ludhiana, Punjab, India
| | - Shashikant Apte
- Department of Clinical Haematology, Sahayadri Hospital, Pune, Maharashtra, India
| | - Vijay Vohra
- Department of Liver Transplant Anaesthesia, Medanta the Medicity, Gurugram, Haryana, India
| | - Gajendra Gupta
- Medical Director and Head, Laboratory and Blood Bank, Santokhba Durlabhji Hospital, Jaipur, Rajasthan, India
| | - Aseem K Tiwari
- Department of Transfusion Medicine, Medanta the Medicity, Gurugram, Haryana, India
| | - Anjali Rani
- Department of Liver Transplant Anaesthesia, Max Superspeciality Hospital, New Delhi, India
| | - Shweta A Singh
- Department of Obstetrics and Gynaecology, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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Somnuke P, Ramlee R, Ratanapaiboon W, Thommaaksorn P, Iramaneerat C, Duangekanong S, Siriussawakul A. Factors influencing preoperative chest radiography request for elective endoscopic procedures among medical personnel. PLoS One 2020; 15:e0242140. [PMID: 33186394 PMCID: PMC7665807 DOI: 10.1371/journal.pone.0242140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 10/27/2020] [Indexed: 11/18/2022] Open
Abstract
Background Chest radiography is not routinely recommended before elective endoscopies. A high incidence of perioperative chest radiography requests was observed at our institution. This study aims to investigate factors influencing preoperative chest radiography request for patients undergoing elective gastrointestinal (GI) endoscopies. Methods This cross-sectional clinical study recruited 264 participants from different medical specialties who were responsible for preoperative endoscopic chest x-ray (CXR) ordering including anesthesiologists, surgeons and gastroenterologists. They completed questionnaires exploring their general knowledge and attitudes about preoperative chest radiography. Demographic characteristic of the participants affecting the knowledge on preoperative chest radiography was determined. A Structural Equation Model (SEM) was constructed from validated conceptual framework to find causal relationships between hypothesized factors and intention for preoperative endoscopic chest radiography request. Statistical analyses were performed using the SPSS software version 18.0 and Analysis of Moment Structures (AMOS) version 18.0. Results The questionnaire response rate was 53.79%. Baseline general knowledge on preoperative chest radiography of the participants was comparable. The SEM results showed unsupported relationship between hypothesized factors and the intention for preprocedural GI endoscopic CXR request (p < 0.1). Conclusions General knowledge of medical personnel on tuberculosis needs improvement. To rectify the unnecessary chest radiography request before elective GI endoscopic procedures, awareness of the patients’ health conditions, adherence to the hospital’s policy and realizing of possible patient-related mishaps are not the determinants for preprocedural endoscopic chest radiography request. Future works are required to explore other alternative factors involved for reducing chest radiography requests which are not indicated.
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Affiliation(s)
- Pawit Somnuke
- Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Rachaneekorn Ramlee
- Integrated Perioperative Geriatric Excellent Research Center, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Passorn Thommaaksorn
- Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Cherdsak Iramaneerat
- Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Somsit Duangekanong
- Graduate School of Advanced Technology Management, Faculty of Information Technology and Management, Assumption University, Bangkok, Samuthprakarn, Thailand
| | - Arunotai Siriussawakul
- Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Integrated Perioperative Geriatric Excellent Research Center, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
- * E-mail:
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Kaplan DJ, Haskel JD, Dweck EE, Collins M, Mefta M, Long WJ, Schwarzkopf R. The Association between Reasons for a Rapid Response Team Alert and Immediate Patient Management in Total Hip Arthroplasty Patients. J Arthroplasty 2020; 35:3214-3222. [PMID: 32703711 DOI: 10.1016/j.arth.2020.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 05/15/2020] [Accepted: 06/12/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The purpose of this study is to evaluate the value and efficacy of rapid response teams (RRTs) for different triggering events in total hip arthroplasty (THA) patients. METHODS A retrospective review of all RRT events at a single, tertiary referral center from 2014 to 2016 was performed. Inclusion criteria were defined as patients >18 years old that underwent primary or revision THA. Information queried included demographics, primary reason for RRT, Charlson Comorbidity Index (CCI), underlying etiology, whether any changes in management occurred, and whether the patient was uptriaged. RESULTS In total, 168 RRTs were called on 153 hip arthroplasty patients (mean age 65.2 ± 14.1 years; mean body mass index 32.3 ± 4.8, 66% female). Length of stay in RRT for primary and revision THA was 3.4 and 6.2 days, respectively. This was significantly longer than the length of stay for primary THA patients (2.4 days, P < .001) and revision THA patients (4.6 days, P = .005) that did not require an RRT. There were no mortalities. RRTs for hypotension/presyncope (11%) and for syncope (11%) resulted in significantly fewer changes in management (P < .01) than tachycardia (77%), hypoxia (57%), AMS (79%), and other (47%). RRTs for hypotension/presyncope (28%), syncope (15%), and hypoxia (30%) resulted in significantly fewer patients being uptriaged (P < .001) than tachycardia (81%). Hypotension/presyncope was found to be significantly more commonly due to volume depletion (67%) (P < .001) than other etiologies. Hypoxia was significantly more commonly due to atelectasis (57%) and opioids/oversedation (30.4%) (P = .037). AMS/delirium was also significantly more commonly caused by opioids/over-sedation (71%) (P < .001). CONCLUSION In patients undergoing THA, RRTs for hypotension/presyncopal symptoms and syncope were significantly less likely to result in changes in management or uptriaging compared to tachycardia. The most common etiologies were potentially preventable, including volume depletion and opioid use.
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Affiliation(s)
- Daniel J Kaplan
- Orthopaedic Surgery Department, NYU Langone Health, New York, NY
| | | | - Ezra E Dweck
- Department of Internal Medicine, NYU Langone Health, New York, NY
| | - Michael Collins
- Orthopaedic Surgery Department, NYU Langone Health, New York, NY
| | - Morteza Mefta
- Orthopaedic Surgery Department, NYU Langone Health, New York, NY
| | - William J Long
- Orthopaedic Surgery Department, NYU Langone Health, New York, NY
| | - Ran Schwarzkopf
- Orthopaedic Surgery Department, NYU Langone Health, New York, NY
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8
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Kaur TS, Chatterjee BP. "Too much information with little meaning," relevance of preoperative laboratory testing in elective oral and maxillofacial surgeries: A systematic integrative review. Natl J Maxillofac Surg 2020; 11:3-9. [PMID: 33041569 PMCID: PMC7518500 DOI: 10.4103/njms.njms_60_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 12/12/2019] [Accepted: 02/02/2020] [Indexed: 12/19/2022] Open
Abstract
Aim: In the recent times due to accessibility of tools and advent of technology advising battery of laboratory tests prior to any electeve surgical procedure has become a norm. This review aims at investigating relevance of such tests in healthy patients undergoing routine elective oral and maxillofacial surgical procedures. Methods: Various search engines were thoroughly searched to identify relevant literature. The population of interest was asymptomatic adults above 18 years of age undergoing elective surgery. Results: The preoperative tests of interest for the current study included complete blood count, coagulation tests, biochemistry, and chest X-rays. An algorithm for preoperative tests has been proposed. Conclusion: We conclude that advising battery of routine tests in such patients leads to further delays and rise in overall cost of the surgery.
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Affiliation(s)
- Taranjit S Kaur
- Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, Jamnagar, Gujarat, India
| | - Bijoya P Chatterjee
- Department of Biochemistry, M. P. Shah Government Medical College, Guru Gobind Singh Government Hospital, Jamnagar, Gujarat, India
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Siddaiah H, Patil S, Shelvan A, Ehrhardt KP, Stark CW, Ulicny K, Ridgell S, Howe A, Cornett EM, Urman RD, Kaye AD. Preoperative laboratory testing: Implications of "Choosing Wisely" guidelines. Best Pract Res Clin Anaesthesiol 2020; 34:303-314. [PMID: 32711836 DOI: 10.1016/j.bpa.2020.04.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 04/07/2020] [Indexed: 01/15/2023]
Abstract
Preoperative laboratory testing is often necessary and can be invaluable for diagnosis, assessment, and treatment. However, performing routine laboratory tests for patients who are considered otherwise healthy is not usually beneficial and is costly. It is estimated that $18 billion (U.S.) is spent annually on preoperative testing, although how much is wasteful remains unknown. Ideally, a targeted and comprehensive patient history and physical exam should largely determine whether preprocedure laboratory studies should be obtained. Healthcare providers, primarily anesthesiologists, should remain cost-conscious when ordering specific laboratory or imaging tests prior to surgery based on available literature. We review the overall evidence and key points from the Choosing Wisely guidelines, the identification of potential wasteful practices, possible harms of testing, and key clinical findings associated with preoperative laboratory testing.
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Affiliation(s)
- Harish Siddaiah
- Department of Anesthesiology, LSU Health Shreveport, Shreveport, LA, USA.
| | - Shilpadevi Patil
- Department of Anesthesiology, LSU Health Shreveport, Shreveport, LA, USA.
| | | | - Kenneth Philip Ehrhardt
- Department of Anesthesiology, LSU Health New Orleans, 1542 Tulane Ave, Room 659, New Orleans, LA, 70112, USA.
| | - Cain W Stark
- Medical College of Wisconsin, 8701 West Watertown Plank Road, Wauwatosa, WI, 53226, USA.
| | - Kenneth Ulicny
- Department of Anesthesiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA.
| | - Sasha Ridgell
- Department of Anesthesiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA.
| | - Austin Howe
- Department of Anesthesiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA.
| | - Elyse M Cornett
- Department of Anesthesiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA.
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA.
| | - Alan D Kaye
- Departments of Anesthesiology and Pharmacology, Toxicology, and Neurosciences, LSU Health Shreveport, 1501 Kings Highway, Shreveport LA, 71103, USA.
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Guttikonda N, Nileshwar A, Rao M, Sushma TK. Preoperative laboratory testing - Comparison of National Institute of Clinical Excellence guidelines with current practice - An observational study. J Anaesthesiol Clin Pharmacol 2019; 35:227-230. [PMID: 31303713 PMCID: PMC6598565 DOI: 10.4103/joacp.joacp_342_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background and Aims: Preoperative laboratory testing is done to detect abnormalities in the body not detected by clinical examination. Often a battery of tests is advocated as a routine for patients scheduled for low or intermediate risk surgery. This prospective observational study was aimed to assess agreement of the current practice of preoperative laboratory investigations with the National Institute of Clinical Excellence (NICE) guidelines, and the impact of investigations on patient care and costs. Material and Methods: The study was conducted at a tertiary referral center on 385 patients aged 18-70 years of either gender, posted for elective general surgical, gynaecological or otolaryngological surgery. Sixteen investigations were examined: hemogram, blood urea, serum creatinine, serum electrolytes, coagulation profile, urinalysis, thyroid function tests, electrocardiogram, echocardiogram, chest x-ray, pulmonary function tests, blood sugar, glycosylated hemoglobin, liver function tests, treadmill test and coronary angiogram. The history and physical examination were reviewed to examine for indication for these laboratory investigations. These were compared with NICE guidelines. Impact of these investigations on anesthetic decision-making was noted. Results: There was almost no agreement of the current practice with the NICE guidelines. The total cost of all tests obtained was Rs 5,48,755. Total additional cost of unindicated tests was Rs 5,10,730 (93%). Average amount spent on additional investigations per patient was Rs 1326.57. Conclusion: Most investigations are overprescribed and have minimal agreement with NICE guidelines. None of the tests had any impact on clinical care. Nearly a million rupees is incurred per year in one referral hospital alone, when NICE guidelines are not followed.
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Affiliation(s)
- Neeraj Guttikonda
- Department of Anaesthesiology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Anitha Nileshwar
- Department of Anaesthesiology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Madhu Rao
- Department of Anaesthesiology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - T K Sushma
- Department of Anaesthesiology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
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Testing Times: Routine to Indicated! Anesth Analg 2018; 126:1451-1452. [PMID: 29672385 DOI: 10.1213/ane.0000000000002880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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13
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Reazaul Karim HM, Prakash A, Sahoo SK, Narayan A, Vijayan V. Abnormal routine pre-operative test results and their impact on anaesthetic management: An observational study. Indian J Anaesth 2018; 62:23-28. [PMID: 29416147 PMCID: PMC5787886 DOI: 10.4103/ija.ija_223_17] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND AND AIMS One of the reasons for continued routine pre-operative testing practice is the identification of hidden problems which may affect perioperative management. This study was aimed to assess the prevalence of abnormal test results, their impact on perioperative management and cost-effectiveness for detecting such abnormalities. METHODS This observational study was conducted by screening the files of the patients attending pre-anaesthetic check-up during December 2016-January 2017. Patients' physical status, surgery grade, normal and abnormal test results and different impacts were noted and expressed in absolute numbers/percentage. Number needed to investigate (NNI) to detect a significant abnormality was calculated. RESULTS Data of 414 patients (46.3% male) with mean ± standard deviation age 43.78 ± 17.24 years and 58.65 ± 12.93 kg weight were analysed. Patients were mostly American Society of Anesthesiologists II and underwent National Institute of Clinical and Health Excellence Grade 3 surgeries. Totally, 345 (11.6%) test results were abnormal. Only 56 (16.2%) abnormalities had an impact in terms of referral, further investigations or delay. Twenty were significant in terms of changing perioperative anaesthetic management. Laboratory abnormalities with non-significant impact resulted in median delay of 3 days (range 1 to 12 days). The NNI for a significant impact and detecting new abnormality was 21 and 28, respectively. CONCLUSION Majority (57.2%) of the patients had at least one abnormal routine test result but only 1.8% abnormalities had significant impact. The NNI to find a significant impact or hidden comorbidity was more than 20.
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Affiliation(s)
- Habib Md Reazaul Karim
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Avinash Prakash
- Department of Anaesthesiology, Andaman and Nicobar Islands Institute of Medical Sciences and GB Pant Hospital, Port Blair, Andaman and Nicobar Islands, India
| | - Sarasa Kumar Sahoo
- Department of Anaesthesiology, Andaman and Nicobar Islands Institute of Medical Sciences and GB Pant Hospital, Port Blair, Andaman and Nicobar Islands, India
| | - Anilkumar Narayan
- Department of Anaesthesiology, Andaman and Nicobar Islands Institute of Medical Sciences and GB Pant Hospital, Port Blair, Andaman and Nicobar Islands, India
| | - Vidya Vijayan
- Department of Anaesthesiology, Andaman and Nicobar Islands Institute of Medical Sciences and GB Pant Hospital, Port Blair, Andaman and Nicobar Islands, India
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Karim HMR. Practice and reasons for routine pre-operative investigations among anaesthesiologists and surgeons: An online survey. Indian J Anaesth 2017; 61:933-935. [PMID: 29217861 PMCID: PMC5703009 DOI: 10.4103/ija.ija_92_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- Habib Md Reazaul Karim
- Department of Anaesthesiology, Andaman and Nicobar Islands Institute of Medical Sciences and GB Pant Hospital, Port Blair, Andaman and Nicobar Islands, India
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15
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Md Reazaul Karim H. ADOPTING INFORMATION MANAGEMENT BASED JOINT PREOPERATIVE ASSESSMENT AND RISK STRATIFICATION MODEL TO SAVE SURGICAL CARE COST. ACTA ACUST UNITED AC 2017. [DOI: 10.15436/2377-1364.17.059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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