THE UTILITY OF PREOPERATIVE LABORATORY TESTING IN GENERAL-SURGERY PATIENTS FOR OUTPATIENT PROCEDURES

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.