Preoperative laboratory evaluation of patients aged over 40 years undergoing elective non-cardiac surgery
Keywords:
Preoperative care, Blood tests, Routine diagnostic tests, Intraoperative complications, Laboratory techniques and proceduresAbstract
CONTEXT AND OBJECTIVE: Although it is gener- ally agreed that a medical history and physical examination should be obtained as part of preoperative evaluation, there is still substantial controversy about the additional benefits of preoperative screening tests. The objective of the present study was to determine the percentage of abnormalities on laboratory tests among a population that underwent non-cardiac surgery and to correlate these tests with changes in preoperative evaluation management. DESIGN AND SETTING: Cross-sectional study, carried out in a University Hospital. METHODS: 991 patients aged over 40 years undergoing elective non-cardiac surgery from July 1997 to January 2000 were studied. Blood cell count, serum sodium, potassium, urea and creatinine, prothrombin, thrombin and partial thromboplastin time, electrocardiogram and chest X-ray were evaluated. RESULTS: Out of the 957 electrocardiograms performed, some type of abnormality was found in 504 cases (50.9%) and, among the 646 chest X-rays requested, 271 (42.0%) displayed alterations. Laboratory tests showed abnormal values ranging from 5.1% (prothrombin time) to 41.0% (hematocrit). Increased percentages of abnormal tests with increasing patient age were also observed. CONCLUSIONS: Although there were substantial numbers of screening test abnormalities in preoperative evaluations, these results seldom interfered in patient management.
Downloads
References
Roizen M. Preoperative patient evaluation. Can J Anaesth. 1989;36(3 Pt 2) :S13-9.
Relman AS. Assessment and accountability: the third revolution in medical care. N Engl J Med. 1988;319(18):1220-2.
Kaplan EB, Sheiner LB, Boeckmann AJ, et al. The usefulness of preoperative laboratory screening. JAMA. 1985;253(24):3576-81.
Blery C, Charpak Y, Szatan M, et al. Evaluation of a pro- tocol for selective ordering of preoperative tests. Lancet. 1986;1(8473):139-41.
Eisenberg JM, Clarke JR, Sussman SA. Prothrombin and partial thromboplastin times as preoperative screening tests. Arch Surg. 1982;117(1):48-51.
Suchman AL, Mushlin AI. How well does the activated partial thromboplastin time predict postoperative hemorrhage? JAMA. 1986;256(6):750-3.
Kroenke K, Hanley JF, Copley JB, et al. The admission urinalysis: impact on patient care. J Gen Intern Med. 1986;1(4):238-42.
Jakobsson A, White T. Routine preoperative electrocardiograms. Lancet. 1984;1(8383):972.
Hubbell FA, Greenfield S, Tyler JL, Chetty K, Wyle FA. The impact of routine admission chest x-ray films on patient care. N Engl J Med. 1985;312(4):209-13.
Roizen MF. Preoperative evaluation of patients: a review. Ann Acad Med Singapore. 1994;23(6 Suppl):49-55.
Fourrier P. Réflexions sur les bilans pré-opératoires systé- matiques. [Systematic preoperative evaluation]. Chirurgie. 1990;116(3):320-4; dicussion 324-5.
France FH, Lefebvre C. Cost-effectiveness of preoperative examinations. Acta Clin Belg. 1997;52(5):275-86.
Palda VA, Detsky AS. Perioperative assessment and manage- ment of risk from coronary artery disease. Ann Intern Med. 1997;127(4):313-28.
Donovan TR, Donovan PG. The future is now. In: Wetcheler BU, editor. Anesthesia for ambulatory surgery. 1st ed. Philadel- phia: JB Lippincott; 1985. p. 4-5.
Delahunt B, Turnbull PR. How cost effective are routine preoperative investigations? N Z Med J. 1980;92(673):431-2.
Muskett AD, McGreevy JM. Rational preoperative evaluation. Postgrad Med J. 1986;62(732):925-8.
Allison JG, Bromley HR. Unnecessary preoperative investigations: evaluation and cost analysis. Am Surg. 1996;62(8):686-9.
Marcello PW, Roberts PL. “Routine” preoperative studies. Which studies in which patients? Surg Clin North Am. 1996;76(1):11-23.
McCleane GJ. Urea and electrolyte measurement in pre-opera- tive surgical patients. Anaesthesia. 1988;43(5):413-5.
Macpherson CR, Jacobs P, Dent DM. Abnormal peri-opera- tive haemorrhage in asymptomatic patients is not predicted by
laboratory testing. S Afr Med J. 1993;83(2):106-8.
Howells RC, Wax MK, Ramadan HH. Value of preoperative prothrombin time/partial thromboplastin time as a predictor of postoperative hemorrhage in pediatric patients undergoing tonsil- lectomy. Otolaryngol Head Neck Surg. 1997;117(6):628-32.
Boghosian SG, Mooradian AD. Usefulness of routine preopera- tive chest roentgenograms in elderly patients. J Am Geriatr Soc. 1987;35(2):142-6.
Rucker L, Frye EB, Staten MA. Usefulness of screening chest roentgenograms in preoperative patients. JAMA. 1983;250(23):3209-11.
Narr BJ, Hansen TR, Warner MA. Preoperative labora- tory screening in healthy Mayo patients: cost-effective elimination of tests and unchanged outcomes. Mayo Clin Proc. 1991;66(2):155-9.
Macpherson DS. Preoperative laboratory testing: should any tests be “routine” before surgery? Med Clin North Am. 1993;77(2):289-308.
