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Pre-operative haemoglobin estimation in paediatric ENT surgery
1Russells Hall Hospital, Dudley, West Midlands.
Insights
Routine pre-operative hemoglobin testing in children undergoing ENT surgery is unnecessary and costly. Evidence suggests it is safe to forgo this test, potentially saving significant funds annually.
Area of Science:
- Pediatric Surgery
- Hematology
- Anesthesia
Background:
- Routine pre-operative hemoglobin estimation is common practice before ENT surgery.
- This practice is questioned due to being unnecessary, traumatic, and expensive.
Purpose of the Study:
- To evaluate the necessity and safety of routine pre-operative hemoglobin estimation in children undergoing ENT surgery.
Main Methods:
- Hemoglobin levels were assessed in 372 children scheduled for ENT surgery over one year.
- Clinical anemia and hemoglobin levels below 9 g/dL were monitored.
- Outcomes for children with hemoglobin levels ≤10.5 g/dL were analyzed.
Main Results:
- No children presented with clinical anemia or hemoglobin <9 g/dL.
- 18 children had hemoglobin levels ≤10.5 g/dL; 10 had operations postponed, 8 proceeded without complications.
- No adverse events were observed in children who underwent surgery with mild anemia.
Conclusions:
- Routine pre-operative hemoglobin testing in children for ENT surgery is not supported by evidence.
- Discontinuing this routine testing can lead to significant cost savings without compromising patient safety.
- Further research should confirm the safety of operating on children with mild anemia.
Abstract:
Estimation of haemoglobin is still undertaken routinely before ENT surgery in many centres despite evidence that it is unnecessary, traumatic and expensive. The haemoglobin was estimated of all 372 children about to undergo ENT surgery in a busy district general hospital over a one year period. No child was noted to be clinically anaemic, and no child had a haemoglobin of less than 9 g/dl. Of 18 children with a haemoglobin level of 10.5 or less, 10 had their operations postponed and eight did not. There were no complications in the latter group. We can find no published evidence that operating on children with mild anaemia is unsafe. Ceasing routine pre-operative haemoglobin estimation would safely save an estimated 9000 pounds per year in our unit.