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Preoperative Testing for Urethroplasty is Not Associated With Outcomes-A NSQIP Study.

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  • 1Case Western Reserve University School of Medicine, Cleveland, OH; University Hospitals Cleveland Medical Center - Urology Institute, Cleveland, OH.

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|February 29, 2020
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Summary

Routine preoperative lab testing before urethroplasty does not impact outcomes for most patients. Abnormal results in patients with American Society of Anesthesiologists (ASA) class 2 or lower did not predict complications.

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Area of Science:

  • Urology
  • Surgical Quality Improvement
  • Preoperative Assessment

Background:

  • Routine preoperative laboratory testing is common practice before urethroplasty.
  • The clinical significance and impact of these tests on patient outcomes remain unclear.

Purpose of the Study:

  • To evaluate the current use of routine preoperative laboratory tests before urethroplasty.
  • To determine if preoperative test results are clinically significant and affect postoperative outcomes.

Main Methods:

  • Analysis of data from the National Surgical Quality Improvement Program (NSQIP) database (2010-2017).
  • Inclusion of 1527 patients who underwent urethroplasty.
  • Statistical analysis including chi-square, ANOVA, and multivariable logistic regression to compare outcomes between patients with normal and abnormal preoperative labs.

Main Results:

  • Over 8,400 tests were performed on 1156 patients, with only 11.3% showing abnormal results.
  • Patients with abnormal labs were older, more likely to be smokers, have diabetes, dyspnea, or higher American Society of Anesthesiologists (ASA) class.
  • Abnormal preoperative tests did not predict complications in patients with ASA class ≤2. In patients with ASA class ≥3, only abnormal coagulation predicted complications.

Conclusions:

  • Routine preoperative laboratory testing does not appear to influence postoperative outcomes in patients undergoing urethroplasty, particularly those with ASA class ≤2.
  • Preoperative testing may be overutilized, suggesting a need to refine testing protocols based on patient risk stratification.