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Preoperative laboratory testing of children undergoing elective surgery
1Department of Pediatrics and Anesthesia, San Francisco General Hospital, University of California 94110.
Anesthesia and Analgesia
|February 1, 1990
Summary
Routine urinalysis (UA) in healthy children undergoing elective surgery rarely impacts care. Most abnormal UA results are insignificant, and omitting this test may improve preoperative efficiency.
Area of Science:
- Pediatric Surgery
- Preoperative Assessment
- Clinical Laboratory Diagnostics
Background:
- Standard preoperative evaluations for pediatric elective surgeries include history, physical examination, complete blood count, and urinalysis (UA).
- The clinical significance of abnormal laboratory findings in otherwise healthy children undergoing elective procedures is often unclear.
- Evaluating the necessity of routine preoperative urinalysis in pediatric patients is crucial for optimizing perioperative management.
Purpose of the Study:
- To retrospectively assess the impact of abnormal preoperative laboratory test results on the perioperative management of pediatric patients.
- To determine the specific contribution and clinical utility of routine urinalysis in the preoperative evaluation of children scheduled for elective surgery.
Main Methods:
- Retrospective review of medical records for 486 pediatric patients undergoing elective surgeries.
- Analysis of preoperative laboratory results, including complete blood count and urinalysis (UA).
- Evaluation of the correlation between abnormal test results and perioperative management decisions, including surgery cancellations and complications.
Main Results:
- Anemia or microcytosis was identified in 17% of patients, and abnormal UA results were found in 15%.
- Over 80% of abnormal UA results were historically known, clinically insignificant, or false-positive.
- Surgery was canceled in only five children due to abnormal tests (two for anemia, two for UA, one for prolonged PTT); subsequent management was successful for most.
Conclusions:
- Routine preoperative urinalysis (UA) provides minimal additional value in the preoperative assessment of healthy pediatric patients.
- The high rate of insignificant or false-positive UA results suggests this test is often unnecessary.
- Omitting routine UA in the preoperative evaluation of healthy children may streamline the process without compromising patient safety.
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