title: The unproven utility of the preoperative urinalysis: economic evaluation.
abstract: The clinical effectiveness of the preoperative urinalysis is unproven, yet it is routinely obtained before surgery. To determine if the routine urinalysis might be economically beneficial, we evaluated its cost-effectiveness and cost-benefit. In the setting of elective clean-wound, non-prosthetic knee procedures, we estimated that: (1) nearly U.S. $7,000,000 is spent annually on preoperative urinalyses and associated costs; (2) given the best estimate of the increase in risk of wound infection attributable to urinary tract infection, 4.58 wound infections may be prevented annually, at a cost of $1,500,000 per wound infection prevented; (3) the cost of treating additional cases of wound infection, given no preoperative urinalysis, is approximately five hundred-fold less than the cost of screening with routine urinalyses. We conclude that the routine preoperative urinalysis is clinically and economically unsound before clean-wound, non-prosthetic knee surgery and probably before other types of clean-wound surgery. For this relatively inexpensive test, aggregate costs are disproportionately high and appear to outweight clinical benefits.
authors.affiliation: Department of Medicine, University of Texas Health Science Center, San Antonio 78284-7879.
authors.forename: V A
authors.initials: VA
authors.lastname: Lawrence
authors.forename: A
authors.initials: A
authors.lastname: Gafni
authors.forename: M
authors.initials: M
authors.lastname: Gross
mesh_terms: D000368:Aged; D003362:Cost-Benefit Analysis; D006801:Humans; D007717:Knee / Q000601:surgery; D008875:Middle Aged; D011300:Preoperative Care / Q000191:economics*; D011379:Prognosis; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000191:economics* / Q000209:etiology; D014552:Urinary Tract Infections / Q000150:complications / Q000175:diagnosis*