Ta. Wattsman et Rs. Davies, THE UTILITY OF PREOPERATIVE LABORATORY TESTING IN GENERAL-SURGERY PATIENTS FOR OUTPATIENT PROCEDURES, The American surgeon, 63(1), 1997, pp. 81-89
The utility of obtaining routine preoperative laboratory (lab) screeni
ng tests was evaluated for a 1-year period in general surgery clinic p
atients undergoing ambulatory surgical procedures at a teaching hospit
al. This study sought to determine whether those lab tests not indicat
ed by patient history or physical examination would identify abnormali
ties that might influence perioperative care of the ambulatory surgica
l patient or predict perioperative complications. The charts of 142 pa
tients undergoing 155 procedures were reviewed. A total of 300 tests w
ere ordered, with 92 (30.6%) being abnormal. Of the 125 tests indicate
d, 54 (43.2%) were abnormal, whereas in those lab tests not indicated,
38 (21.7%) were found to be abnormal. In four instances, an abnormal
lab test (4 out of 300) result was clinically significant (1.3%), caus
ing cancellation of the surgical procedure in two cases (both indicate
d lab tests) and diagnosis of urinary tract infection in two patients
(both routine urinalyses). Forty-eight of the 142 patients had no preo
perative lab tests ordered (34%), with no perioperative complications
resulting. Patient charges totaled $15,725 for all lab tests ordered,
with $8,573 in charges attributed to those tests not indicated. If lab
tests for all general and subspecialty surgical outpatients had been
ordered as dictated by patient medical history and physical examinatio
n rather than by either routine or by arbitrary criteria, our medical
facility could have potentially reduced patient charges by more than $
400,000 in the year reviewed, assuming a 52.4 per cent savings as note
d above, with no expected adverse outcomes.