Incorporation of Evidence-based Guidelines on Bleeding Risk Assessment Prior to Surgery into Practice: Real-time...

Area of Science:

• Medical Research
• Surgical Outcomes
• Clinical Practice Guidelines

Background:

• Guidelines suggest preoperative coagulation testing is unnecessary for patients with no bleeding history.
• Surgeons in certain regions frequently order coagulation tests despite these recommendations.
• Overuse of testing can lead to inefficiencies in surgical workflows.

Purpose of the Study:

• To evaluate hemostatic outcomes in ear, nose, and throat (ENT) surgeries.
• To assess the prevalence and rationale behind surgeons' preoperative coagulation testing practices.
• To provide unbiased estimates of bleeding risks in ENT procedures.

Main Methods:

• A study involving 730 patients undergoing ENT surgeries between July 2017 and January 2018.
• Patients were divided into two groups: history of bleeding assessment alone versus preoperative coagulation testing.
• Surgeons were surveyed regarding their testing decisions and reasons.

Main Results:

• 372 patients relied on bleeding history alone, while 358 underwent preoperative coagulation testing.
• Over half of the tested patients had repeat testing or advanced assays like coagulation factor and Von Willebrand factor assays.
• Habitual practice was the primary reason cited by surgeons for performing coagulation tests.

Conclusions:

• Nearly half of local surgeons consider coagulation testing a routine measure for surgical bleeding risk assessment.
• This practice contributes to unnecessary surgical delays, patient anxiety, and increased healthcare costs.
• Awareness campaigns and surgical society involvement are recommended to promote adherence to detailed hemostatic history guidelines.