Pursuit of abnormal coagulation screening tests generates modest hidden preoperative costs

To measure the follow-up costs of preoperative coagulation screening tests, the authors studied 829 consecutive patients undergoing inpatient orthopedic surgery. The results of the initial prothrombin and activated partial thromboplastin time tests were divided into three groups: normal; abnormal above the hospital laboratory's upper limit of normal but below an "action limit"; and abnormal above an action limit. Patients with abnormal preoperative coagulation screening test results were matched on the basis of operative procedure and age with patients who had normal results. The matched groups of patients were compared according to preoperative length of stay and the cost of subsequent related preoperative testing. The average cost of follow-up preoperative testing for patients with abnormal screening test results was $5.05, compared with $0.58 for patients with normal screening results. The difference in average preoperative lengths of stay was not statistically significant. The attributable cost of evaluating an abnormal result added 3% to the cost of the initial coagulation screening program. This represents an average preoperative cost of $0.36 per patient in addition to the cost of the screening tests themselves.