How cost effective are routine preoperative investigations?

Area of Science:

• Preoperative assessment
• Surgical patient management
• Diagnostic testing in surgery

Background:

• Preoperative assessment of patients for elective surgery is standard practice.
• The utility of routine laboratory investigations in asymptomatic patients is debated.
• Wellington Hospital conducted a study on patients undergoing varicose vein and inguinal hernia surgery.

Purpose of the Study:

• To evaluate the necessity and impact of routine preoperative laboratory investigations.
• To determine if routine tests alter patient management or predict adverse outcomes.
• To assess the cost-effectiveness of preoperative testing in elective minor surgery.

Main Methods:

• Reviewed 860 patients undergoing elective varicose vein and inguinal hernia surgery.
• Analyzed data from 1792 routine radiological and laboratory tests (e.g., chest x-ray, blood tests).
• Correlated test results with patient outcomes and management decisions.

Main Results:

• Only 8 patients were deemed unfit for anesthesia; 49 had no investigations.
• Abnormal results were found in 172 patients, with 63 unexpected findings.
• No significant respiratory, renal, or wound pathology was detected, and no unexpected results altered management.

Conclusions:

• Routine preoperative laboratory investigations for asymptomatic patients undergoing elective minor surgery lack justification.
• Current practices of extensive preoperative testing may be unnecessary and costly.
• Focusing on clinical assessment may be more efficient for selecting patients for further investigation.