title: Use and Utility of Hemostatic Screening in Adults Undergoing Elective, Non-Cardiac Surgery.
abstract: BACKGROUND
  One view of value in medicine is outcome relative to cost of care provided. With respect to operative care, increased attention has been placed on evaluation and optimization of patients prior to undergoing an elective surgery. We examined more than 2 million patients having elective, non-cardiac surgery to assess the incidence and utility of pre-operative hemostatic screening, compared with a composite of history variables that may indicate a propensity for bleeding, to assess several important outcomes of surgery.
  
  
  METHODS
  We queried the NSQIP database to identify 2,020,533 patients and compared hemostatic tests (PT, aPTT, platelet count) and history covariables indicative of potential for abnormal hemostasis. We compared outcomes across predictor values; used Person's chi-square tests to compare differences, and logistic regression to model outcomes.
  
  
  RESULTS
  Approximately 36% of patients had all three tests pre-operatively while 16% had none of them; 11.2% had a history predictive of potential abnormal bleeding. Outcomes of interest across the cohort included death in 0.7%, unplanned return to the operating room or re-admission within 30 days in 3.8% and 6.2% of patients; 5.3% received a transfusion during or after surgery. Sub-analyses in each of the nine surgical specialties' most common procedures yielded similar results.
  
  
  CONCLUSIONS
  The limited predictive value of each hemostatic screening test, as well as excess costs associated with them, across a broad spectrum of elective surgeries, suggests that limiting pre-operative testing to a more select group of patients may be reasonable, equally efficacious, efficient, and cost-effective.
authors.affiliation: Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, Ohio, United States of America.
authors.forename: Isabel A
authors.initials: IA
authors.lastname: Weil
authors.affiliation: Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, United States of America.|Departments of Pulmonary, Critical Care and Sleep Medicine, University Hospitals, Cleveland, Ohio, United States of America.
authors.forename: Sinziana
authors.initials: S
authors.lastname: Seicean
authors.affiliation: Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, Ohio, United States of America.
authors.forename: Duncan
authors.initials: D
authors.lastname: Neuhauser
authors.affiliation: Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, Ohio, United States of America.
authors.forename: Nicholas K
authors.initials: NK
authors.lastname: Schiltz
authors.affiliation: Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, Ohio, United States of America.
authors.forename: Andreea
authors.initials: A
authors.lastname: Seicean
mesh_terms: D000328:Adult; D017558:Elective Surgical Procedures; D005260:Female; D006403:Hematologic Tests / Q000706:statistics & numerical data*; D006487:Hemostasis; D006801:Humans; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D057234:Preoperative Period