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Preoperative testing in elective surgery: Is it really cost effective?

Priyanga Ranasinghe1, Y Sanja Perera1, J A D Supun Senaratne1

  • 1Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Sri Lanka.

Anesthesia, Essays and Researches
|April 18, 2015
PubMed
Summary

Routine preoperative investigations are often unnecessary and costly. This study found poor compliance with national guidelines at the National Hospital of Sri Lanka, leading to significant excess expenditure on patient care.

Keywords:
Elective surgeryNational Hospital of Sri Lanka (NHSL)Sri Lankapreoperative assessment

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Area of Science:

  • Healthcare Management
  • Clinical Practice Guidelines
  • Health Economics

Background:

  • Preoperative investigations aim to detect asymptomatic diseases before surgery.
  • Routine investigations often yield few significant findings but increase perioperative care costs.
  • Current practices, guideline compliance, and costs of preoperative investigations were evaluated at the National Hospital of Sri Lanka (NHSL).

Purpose of the Study:

  • To assess adherence to national guidelines for preoperative investigations.
  • To determine the cost implications of non-compliance with these guidelines.
  • To identify opportunities for rationalizing preoperative testing practices.

Main Methods:

  • A study was conducted on 2,061 patients undergoing elective surgery at NHSL from June to August 2010.
  • Data were collected using a validated, interviewer-administered questionnaire.
  • Compliance was assessed against the National Guidelines on Preoperative Investigations.

Main Results:

  • Compliance with guidelines was poor for most investigations, with chest X-ray and prothrombin time/international normalized ratio showing the lowest adherence.
  • Only fasting blood sugar/random blood sugar showed good compliance (>70%).
  • Excess costs ranged from LKR. 1,324,860 to 2,044,210 (LKR. 642.82-991.85 per patient) due to non-recommended tests, primarily requested by intern house officers and medical officers/registrars in anesthesia.

Conclusions:

  • Unnecessary preoperative investigations are prevalent at the institution, contributing to substantial excess costs.
  • Significant opportunities exist to optimize preoperative testing protocols and reduce healthcare expenditure.
  • Rationalizing practices can improve efficiency and cost-effectiveness in perioperative care.