Think Twice: De-implementation of Laboratory Testing After Colorectal Surgery

Area of Science:

• Quality Improvement
• Surgical Care
• Laboratory Medicine

Background:

• Clinically unindicated laboratory tests contribute to low-value care.
• Most postoperative day 1 lab tests after colorectal surgery are normal.
• No prior interventions demonstrated the safety of reducing overall postoperative lab testing.

Discussion:

• A quality improvement study at an academic center implemented a reduction in postoperative laboratory testing after colorectal surgery.
• The intervention involved decreasing daily lab tests from 5 to 3 on postoperative day 1, with subsequent tests based on clinical indication.
• This approach was tested in an enhanced recovery after surgery program.

Key Insights:

• The intervention group experienced a 33% reduction in lab tests per hospital stay and a 26% reduction per day.
• Laboratory test-free days increased by 49% post-intervention.
• No significant differences were observed in length of stay or readmission rates between the intervention and nonintervention groups.

Outlook:

• The successful intervention led to a change in the laboratory order set to an opt-out system.
• Laboratory work reduction strategies have been adopted by other surgical divisions.
• Continued implementation and dissemination are crucial for prioritizing high-value surgical care.