Debate on pre operative routine laboratory examination
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Debate on: PRE-OPERATIVE ROUTINE LABORATORY EXAMINATION. Cabahug , Martin Joseph Cruz, Haidee Gonzales, Roberto Estonilo , Edwin Gabrielle, Allan Malabanan , Jonathan. ROUTINE TEST/WORK-UP.

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Debate on pre operative routine laboratory examination


Cabahug, Martin Joseph

Cruz, Haidee

Gonzales, Roberto

Estonilo, Edwin

Gabrielle, Allan

Malabanan, Jonathan

Routine test work up

  • Those that are performed in apparently healthy individuals without indications from patient's clinical history and examination.

Practice point
Practice Point

  • Routine preoperative screening of healthy patients undergoing elective surgery is ineffective, costly and may harm patients .

  • Assessments provide an opportunity to reduce perioperative morbidity .

  • Investigations can only be complimentary to and cannot replace a good clinical history and physical examination .

  • Although screening patients to uncover occult disease appears logical, in reality it has resulted in excessive expenditure with limited benefit.

  • Especially in a developing country like ours where the majority of the population is not covered by medical insurance  cost factors to the patient should be of major consideration .

Shortcomings of doing routine laboratory test on healthy individuals without co-morbidities prior to an elective operation:

  • They can detect abnormalities which may not necessarily improve patient care or outcome.

  • Can be inefficient in screening asymptomatic diseases e.g.: normal ECG does not preclude IHD.

  • Unnecessary testing  may lead physician to pursue and treat borderline and false positive lab abnormalities .

  • Unnecessary tests can increase cost to the patient.

  • Medico-legal liability.

"Routine" preoperative studies. Which studies in which patients?Marcello PW, Roberts PL. SurgClin North Am 1996 Feb;76(1):11-23

  • 60% of routine tests conducted on patients in preparation of their surgery are unnecessary and add an extra $18 billion to the annual health care bill.

Unnecessary preoperative investigations: evaluation and cost analysis.Allison JG, Bromley HR. Am Surg 1996 Aug;62(8):686-9

  • Results of this study indicate that two-thirds of the tests patients undergo in preparation of their surgery are UNNECESSARY

Value of routine preoperative chest x-rays: a meta-analysis. per patient. The authors emphasize the need of changingArcher C, Levy AR, McGregor M. Can J Anaesth 1993 Nov;40(11):1022-7

  • The results of this meta-analysis indicate that only 0.1% of pre-operative chest x-rays that are routinely performed on European and North American patients provide information that affects patient treatment.

Routine preoperative testing: a systematic review of the evidenceMunro J, Booth A, Nicholl J. Health Technol Assess 1997;1(12):i-iv; 1-62

Value of different routine pre-operative tests:

  • Chest x-ray - the results of performing routine pre-operative tests lead to a change in clinical patient management in 0% to 2.1% of patients.

  • The following are Royal College Of Radiologists Recommendations For Use Of Preoperative Chest Radiograms:

    1. Patients  with  acute respiratory infections. 2. Patients  with possible  metastasis. 3. Patients with suspected or established cardio-respiratory disease  who have not had a chest radiograph in the last twelve  months. 4. Recent immigration from countries with T.B. who have not had  chest  X RAY in previous twelve months.

    5. Trauma

Preoperative laboratory testing: should any tests be "routine" before surgery?Macpherson DS. Med Clin North Am 1993 Mar;77(2):289-308

  • Any routine test performed in patients admitted for elective surgery is unjustified, since the percentage of patients who will have abnormal test results is about 0.1-2%.

Thank You detected by the test will have an adverse impact on the surgery.