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Evaluating compliance with institutional preoperative testing guidelines for minimal-risk patients undergoing
Arunotai Siriussawakul1, Akarin Nimmannit, Sirirat Rattana-arpa
1Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand. arunotai.sir@mahidol.ac.th
Biomed Research International
|August 13, 2013
Summary
Preoperative testing compliance for low-risk patients is low, with frequent overtesting of blood urea nitrogen (BUN) and creatinine (Cr). Adhering to guidelines can reduce unnecessary tests and costs.
Area of Science:
- Anesthesiology
- Surgical Care
- Health Economics
Background:
- Preoperative investigations are often overutilized in low-risk patients.
- Compliance with established guidelines for American Society of Anesthesiologists (ASA) Class I patients undergoing elective surgery is not well-documented.
- Unnecessary testing leads to increased healthcare expenditure and potential patient harm.
Purpose of the Study:
- To assess compliance with preoperative investigation guidelines for ASA I patients.
- To identify commonly overused tests and factors influencing non-compliance.
- To evaluate the financial impact of inappropriate preoperative testing.
Main Methods:
- Retrospective analysis of 1,496 adult patients undergoing elective surgery over one year.
- Evaluation of adherence to institute-specific guidelines based on patient age groups.
- Identification of specific tests frequently ordered outside of guideline recommendations.
Main Results:
- Only 12.1% of patients received compliant preoperative testing.
- Blood urea nitrogen (BUN) and creatinine (Cr) tests were the most overprescribed.
- Overinvestigation was more common in major surgeries and younger patients, costing an estimated $200,000.
Conclusions:
- Emphasize adherence to institutional preoperative guidelines to minimize unnecessary testing.
- Reducing overtesting can significantly decrease healthcare costs.
- Standardizing preoperative workups improves efficiency and resource allocation.
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