Assessment of preoperative exams request in a teaching hospital

Authors

  • Eduardo Toshiyuki Moro PUC-SP
  • Vivian Brancalione Gonçalves PUC-SP
  • Gustavo Semedo Taminato PUC-SP
  • Thais Benjamin PUC-SP

Keywords:

anesthesiology, preoperative care, mandatory testing, unnecessary procedures.

Abstract

ABSTRACT
Background: preoperative exams aim to identify disorders that may compromise the patient´s perioperative care. However, unnecessary tests rarely change the outcome, and are expensive to institution. The aim of this study was to evaluate the preoperative tests ordered in Santa Lucinda hospital, Sorocaba - SP. Methods: after approval by the Ethics Committee of PUC-SP University, we assessed pre-anesthetic evaluation of patients undergoing elective surgery from march to August, 2011. We recorded: age, sex, ASA physical status, the presence of coexisting diseases, medication use, type of surgery and preoperative tests. They were classified as sufficient, sufficient with unnecessary tests, insufficient, or insufficient with unnecessary tests. Results: two hundred and nineteen records were evaluated, of which 52% were considered sufficient, but with unnecessary tests. For 24% of patients, the tests were insufficient, with some ordered unnecessarily. To 8% of patients, the tests were insufficient, and only 16% didn´t have insufficient and unnecessary tests. The most frequently ordered tests were hematocrit and hemoglobin. The exams most unnecessarily ordered were coagulation tests and dosage of serum urea. Among the necessary examinations, but unsolicited, there were ECG (27%), electrolytes (13%) and creatinine (11%). Seventy-nine tests showed some kind of problem, but they didn´t change in behavior. Conclusions: preoperative tests unnecessarily ordered are frequent, which do not guarantee that some patients present to surgery without fundamental exams according to their risk group.

Downloads

Download data is not yet available.

Author Biographies

Eduardo Toshiyuki Moro, PUC-SP

Professor do Depto. de Cirurgia FCMS/PUC-SP

Vivian Brancalione Gonçalves, PUC-SP

Médica Residente em Anestesiologia FCMS/PUC-SP

Gustavo Semedo Taminato, PUC-SP

Médico graduado na PUC-SP

Thais Benjamin, PUC-SP

Médica graduada na PUC-SP

References

Mathias LA, Guaratini AA, Gozzani JL, Rivetti LA. Exames laboratoriais pré-operatórios: análise crítica. Rev Bras Anestesiol. 2006;56(6):658-68.

Practice advisory for preanesthesia evaluation: a report by the American Society of Anesthesiologists Task Force on Preanesthesia Evaluation. Anesthesiology. 2002;96:485-96.

Katz RI, Dexter F, Rosenfeld K, Wolf L, Redmond V, Agarwal D, et al. Survey study of anesthesiologists' and surgeons' ordering of unnecessary preoperative laboratory tests. Anesth Analg. 2011;112:207-12.

Benarroch-Gampel J, Sheffield KM, Duncan CB, Brown KM, Han Y, Townsend Jr CM, et al. Preoperative laboratory testing in patients undergoing elective, low-risk ambulatory surgery. Ann Surg. 2012;256: 518-28.

Soares DS, Brandão RBM, Mourão MRN, Azevedo VLF, Figueiredo AV, Trindade ES. Relevância de exames de rotina em pacientes de baixo risco submetidos a cirurgias de pequeno e médio porte. Rev Bras Anestesiol. 2013;63(2):197-201.

Correll DJ, Hepner DL, Chang C, Tsen L, Hevelone ND, Bader AM. Preoperative electrocardiograms: patient factors predictive of abnormalities. Anesthesiology. 2009;110:1217-22.

Ajimura FY, Maia AS, Hachiya A, Watanabe AS, Nunes MP, Martins MA, Machado FS. Preoperative laboratory evaluation of patients aged over 40 years undergoing elective noncardiac surgery. São Paulo Med J. 2005;123:50–3.

Bryson GL, Wyand A, Bragg PR. Preoperative testing is inconsistent with published guidelines and rarely changes management. Can J Anaesth. 2006;53:236-41.

Dzankic S, Pastor D, Gonzalez C, Leung JM. The prevalence and predictive value of abnormal preoperative laboratory tests in elderly surgical patients. Anesth Analg. 2001;93:301–8.

Mantha S, Roizen MF, Madduri J, Rajender Y, Shanti Naidu K, Gayatri K. Usefulness of routine preoperative testing: a prospective single-observer study. J Clin Anesth. 2005;17:51-7.

Liu LL, Dzankic S, Leung JM. Preoperative electrocardiogram abnormalities do not predict postoperative cardiac complications in geriatric surgical patients. J Am Geriatr Soc. 2002;50:1186–91.

Gold BS, Young ML, Kinman JL, Kitz DS, Berlin J, Schwartz JS. The utility of preoperative electrocardiograms in the ambulatory surgical patient. Arch Intern Med. 1992;152:301–5.

Munro J, Booth A, Nicholl J. Routine preoperative testing: a systematic review of the evidence. Health Technol Assess. 1997;1:i-iv, 1–62.

Smetana GW, Macpherson DS. The case against routine preoperative laboratory testing. Med Clin North Am. 2003;87:7–40.

Schein OD, Katz J, Bass EB, Tielsch JM, Lubomski LH, Feldman MA, et al. The value of routine preoperative medical testing before cataract surgery. Study of Medical Testing for Cataract Surgery. N Engl J Med. 2000;342:168-75.

Chung F, Yuan H, Yin L, Vairavanathan S, Wong DT. Elimination of preoperative testing in ambulatory surgery. Anesth Analg. 2009;108:467-75.

Geoges P, Kremer Y, Ledent M, Lechat JP, De Kock M. Does the KCE restrictive policy for preoperative testing lead to increased postoperative complications rate? Acta Anaesthesiol Belg. 2010;61:5-11.

Bisinotto FMB, Pedrini Jr M, Alves AAR, Andrade MAPR. Implantação do serviço de avaliação pré-anestésica em hospital universitário. Dificuldades e resultados. Rev Bras Anestesiol. 2007;57( 2):167-76.

Downloads

Published

2014-04-01

How to Cite

1.
Moro ET, Gonçalves VB, Taminato GS, Benjamin T. Assessment of preoperative exams request in a teaching hospital. Rev. Fac. Ciênc. Méd. Sorocaba [Internet]. 2014Apr.1 [cited 2024Aug.16];16(1):22-5. Available from: https://revistas.pucsp.br/index.php/RFCMS/article/view/15753

Issue

Vol. 16 No. 1 (2014)

Section

Original Article

License

Os autores no momento da submissão transferem os direitos autorais, assim, os manuscritos publicados passam a ser propriedade da revista.

O conteúdo do periódico está licenciado sob uma Licença Creative Commons 4.0, esta licença permite o livre acesso imediato ao trabalho e que qualquer usuário leia, baixe, copie, distribua, imprima, pesquise ou vincule aos textos completos dos artigos, rastreando-os para indexação, passá-los como dados para o software, ou usá-los para qualquer outra finalidade legal.