Evaluating compliance with institutional preoperative testing guidelines for minimal-risk patients undergoing elective surgery.
BACKGROUND
Few investigations preoperatively are important for low-risk patients. This study was designed to determine the level of compliance with preoperative investigation guidelines for ASA I patients undergoing elective surgery. Secondary objectives included the following: to identify common inappropriate investigations, to evaluate the impact of abnormal testing on patient management, to determine factors affecting noncompliant tests, and to estimate unnecessary expenditure.


METHODS
This retrospective study was conducted on adult patients over a one-year period. The institute's guidelines recommend tests according to the patients' age groups: a complete blood count (CBC) for those patients aged 18-45; CBC, chest radiograph (CXR) and electrocardiography (ECG) for those aged 46-60; and CBC, CXR, ECG, electrolytes, blood glucose, blood urea nitrogen (BUN), and creatinine (Cr) for patients aged 61-65.


RESULTS
The medical records of 1,496 patients were reviewed. Compliant testing was found in only 12.1% (95% CI, 10.5-13.9). BUN and Cr testings were the most frequently overprescribed tests. Overinvestigations tended to be performed on major surgery and younger patients. Overall, overinvestigation incurred an estimated cost of US 200,000 dollars during the study period.


CONCLUSIONS
The need to utilize the institution's preoperative guidelines should be emphasized in order to decrease unnecessary testing and the consequential financial burden.
Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand. arunotai.sir@mahidol.ac.th
Arunotai
A
Siriussawakul
Akarin
A
Nimmannit
Sirirat
S
Rattana-arpa
Siritda
S
Chatrattanakulchai
Puttachard
P
Saengtawan
Aungsumat
A
Wangdee
D000293:Adolescent; D000328:Adult; D000368:Aged; D001772:Blood Cell Count; D003187:Compliance; D017558:Elective Surgical Procedures / Q000379:methods*; D004562:Electrocardiography; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D012189:Retrospective Studies; D012306:Risk