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Preoperative testing for fecal occult blood: a questionable practice.

A Sonnenberg¹, W F Townsend

¹Clement J. Zablocki VA Medical Center, Milwaukee, Wisconsin.

The American Journal of Gastroenterology

|October 1, 1992

Summary

Routine fecal occult blood testing (FOBT) before elective surgery offers no benefit and increases costs. Preoperative FOBT leads to unnecessary procedures and delays, negatively impacting surgical outcomes.

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Area of Science:

Medical Economics
Surgical Oncology
Gastroenterology

Background:

The clinical utility of preoperative fecal occult blood testing (FOBT) in asymptomatic patients undergoing elective surgery remains unclear.
Assessing the cost-effectiveness of FOBT in this specific patient population is crucial for optimizing healthcare resource allocation.

Purpose of the Study:

To analyze the costs and benefits of performing preoperative FOBT in patients hospitalized for elective surgical procedures.
To determine if routine FOBT screening provides a net benefit compared to its omission in this cohort.

Main Methods:

A decision tree model was employed to evaluate the economic impact of preoperative FOBT.
Sensitivity analyses (2- and 3-way) were conducted, varying costs and probabilities of diagnostic/therapeutic procedures and their outcomes.

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The model assessed the joint influence of these variables on the overall decision analysis.

Main Results:

Preoperative FOBT was associated with a smaller net benefit compared to omitting the test.
Higher costs and lower net benefits were linked to false-positive FOBT results.
False-positive tests resulted in expenditures for negative gastrointestinal work-ups, increased procedural costs, and surgical delays, diminishing success rates.

Conclusions:

Routine screening for fecal occult blood offers no discernible benefit when performed in patients hospitalized for major surgical procedures.
The findings are robust and insensitive to significant variations in model parameters, reinforcing the conclusion against routine preoperative FOBT.