Preoperative testing for fecal occult blood: a questionable practice.

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.
• 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.