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[Preoperative laboratory screening in healthy children: what is necessary?]
Ilan Keidan1, Uri Elbaz, Ron Bilik
1Pediatric Anesthesia Unit, Department of Anesthesia and Intensive Care, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Insights
Preoperative laboratory testing in healthy children undergoing elective surgery often includes unnecessary tests. A targeted educational program significantly reduced these non-indicated tests, improving pediatric anesthesia practices.
Area of Science:
- Pediatric Anesthesia
- Clinical Practice Guidelines
- Preoperative Medicine
Context:
- Preoperative laboratory testing practices for healthy children undergoing elective surgery vary.
- Current practices were compared against established guidelines from pediatric anesthesia societies.
- Tertiary care hospitals face challenges in standardizing preoperative testing protocols.
Purpose:
- To evaluate current preoperative laboratory testing practices in healthy pediatric surgical patients.
- To assess the impact of an educational intervention on reducing unnecessary preoperative laboratory tests.
- To align clinical practice with American and Israeli pediatric anesthesia guidelines.
Summary:
- A prospective, two-stage study involving 240 children undergoing elective surgery was conducted.
- Stage one data (150 children) revealed high rates of unnecessary preoperative laboratory tests.
- Stage two data (90 children) after an educational program showed a significant reduction in non-indicated tests (32.5% decrease, p < 0.001).
Impact:
- Demonstrates that unnecessary preoperative laboratory testing in children is prevalent.
- Highlights the effectiveness of targeted educational programs in optimizing laboratory test utilization.
- Suggests a scalable approach to improve efficiency and reduce costs in pediatric surgical care.
Abstract:
This study was designed to evaluate the current practice of preoperative laboratory testing in healthy children undergoing elective surgery in a single tertiary general hospital, and compare it to the guidelines published by the American and Israeli societies of pediatric anesthesia. We also evaluated the effects of a pre-designed educational program on that practice. This was a prospective, two stage study. In stage one, data was collected on the practice of the preoperative laboratory tests obtained from children scheduled for elective surgeries. We then conducted training, dedicated to criteria and indications for preoperative laboratory testing in children prior to elective surgery. Following the training, we conducted a second phase observation and data on a second group of children was collected and analyzed. Comparing the two groups of children enabled the evaluation of the benefit of the pre-designed educational program. Two hundred and forty children scheduled for elective surgery during the four months of the study period, were surveyed. In stage one, we enrolled and documented preoperative laboratory data obtained for 150 children. In stage two, we collected data on 90 children. Overall, the incidence of unnecessary laboratory tests in the preoperative period was reduced significantly (by 32.5%, p < 0.001). The incidence of non-indicated tests performed, was also reduced significantly (by 23.1%, P = 0.015). We conclude that the use of unnecessary testing of children before elective surgery is common. A training program designed to address this issue can lead to a reduction in unnecessary testing.