Tradition Versus Value: Is There Utility in Protocolized Postoperative Laboratory Testing After Elective Colorectal...

Standardized postoperative lab testing is a common practice in colorectal surgery. Prior research has shown that such protocols are widely adopted. However, the clinical utility of these routine tests remains unclear. Established knowledge suggests that postoperative monitoring is essential. What is less known is whether these tests lead to meaningful clinical actions. No prior work had resolved the cost-effectiveness of protocolized testing. This gap motivated an investigation into the value of these tests. The study aimed to determine if these tests are clinically warranted.

The study aimed to evaluate the clinical and economic value of routine postoperative lab testing. Specifically, it focused on postoperative day 1 laboratory tests after elective colorectal surgery. The motivation was to assess whether these tests provide actionable results. The researchers wanted to determine if the tests lead to interventions. They also sought to calculate the associated costs. The goal was to compare the frequency of abnormal results with the frequency of interventions. This would help assess the cost-effectiveness of the practice. The study aimed to inform changes in clinical protocols.

The study reviewed data from patients undergoing elective colorectal surgery between 2015 and 2017. Protocolized lab tests on postoperative day 1 were analyzed for abnormalities. The researchers calculated the rate of abnormal lab values. They also tracked whether any interventions followed these results. Medicare outpatient reimbursement rates were used to estimate costs. The total number of patients and lab tests was recorded. The frequency of abnormal results and interventions was quantified. The researchers compared these frequencies to assess clinical utility.

Out of 2252 patients, 8205 lab values were reviewed. Only 4% of these values were abnormal. Hemoglobin, creatinine, potassium, and glucose values were each abnormal in about 3–6%. Only 1% of abnormal results led to interventions. The aggregate cost of these tests was $64,000. This cost was calculated using Medicare reimbursement rates. Abnormal values rarely required further action. The study found no appreciable impact on clinical outcomes. The findings suggest limited clinical utility of routine testing.

The authors propose that routine postoperative lab testing is rarely abnormal. They suggest that these tests rarely require active intervention. The study indicates that such testing increases costs without clinical benefit. The researchers propose replacing protocolized testing with clinically based criteria. They suggest that abnormal results do not often change care plans. The findings suggest that current protocols may be inefficient. The authors conclude that these tests are not cost-effective. They propose that clinical judgment should guide lab testing decisions.