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Is preoperative haemoglobin testing justified in children undergoing minor elective surgery?
W L Roy1, J Lerman, B G McIntyre
1Department of Anaesthesia, Hospital for Sick Children, University of Toronto, Ontario.
Insights
Routine preoperative hemoglobin testing is not necessary for healthy pediatric patients over five years old undergoing minor surgery. The study questions its value for younger children due to low anemia rates and deferral incidence.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Hematology
Background:
- Preoperative hemoglobin determination in pediatric patients undergoing general anesthesia is a debated topic.
- Routine testing aims to identify anemia and prevent complications during surgery.
- The clinical utility of routine hemoglobin testing in specific pediatric surgical populations remains unclear.
Purpose of the Study:
- To evaluate the necessity and value of routine preoperative hemoglobin testing in pediatric patients scheduled for minor surgery.
- To assess the incidence of anemia and its impact on surgical deferral in different pediatric age groups.
- To inform guidelines regarding preoperative hemoglobin assessment in pediatric anesthesia.
Main Methods:
- A retrospective study of 2000 pediatric patients (1 month to 18 years) undergoing minor surgery.
- Patients were categorized into three age groups: ≤1 year, 1-5 years, and >5 years.
- Charts of patients with preoperative hemoglobin <100 g/L were reviewed for anesthetic and surgical outcomes.
Main Results:
- Only 0.5% of patients (11/2000), all >5 years old, had hemoglobin <100 g/L.
- Three patients (27% of anemic) had surgery deferred; eight (73%) proceeded without complications.
- Deferred patients underwent successful surgery after iron therapy, indicating manageable anemia.
Conclusions:
- Routine preoperative hemoglobin testing is not recommended for healthy pediatric patients aged five years and older undergoing minor surgery.
- The low incidence of anemia and surgical deferral in younger pediatric groups (1-5 years) also calls into question the routine use of hemoglobin testing in these patients.
- Clinical judgment and targeted testing may be more appropriate than routine screening in select pediatric populations.
Abstract:
The need for preoperative haemoglobin determination before the administration of general anaesthesia to paediatric patients has long been an issue for debate. This study was undertaken to determine the value of routine preoperative haemoglobin testing in paediatric patients scheduled for minor surgery. Two thousand patients ages one month to 18 yr scheduled for minor surgery were studied. The patients were grouped according to age, Group I less than or equal to yr, Group II 1-5 yr, Group III greater than 5 yr. The charts of patients whose preoperative haemoglobin concentration (Hb) was less than 100 g.L-1 were reviewed at a later date to determine the course of their anaesthesia and surgery. Eleven patients, all of whom were greater than 5 yr (0.5%), had a Hb less than 100 g.L-1. Of these, three patients, 27%, had their surgery deferred, whereas the remaining eight patients, 73%, underwent anaesthesia and surgery without complications. The three patients who were deferred returned for uneventful anaesthesia and surgery following oral iron therapy. We conclude that healthy paediatric patients five years and older scheduled for minor surgery do not require routine Hb determinations. Furthermore, the low incidence of anaemia and low deferral rate of anaemic children, 1-5 yr of age, lead us to question the value of preoperative Hb testing in this age group.