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The usefulness of routine preoperative laboratory tests for one-day surgery in healthy children
L Meneghini1, N Zadra, G Zanette
1Anesthesiology and Intensive Care Institute, University of Padua, Italy.
Insights
Routine preoperative laboratory tests are unnecessary for healthy children undergoing same-day surgery. A thorough clinical assessment is sufficient, reducing costs without impacting patient safety or care quality.
Area of Science:
- Pediatric Surgery
- Anesthesiology
- Clinical Pathology
Background:
- Historically, preoperative laboratory tests were standard for pediatric same-day surgery.
- Concerns exist regarding the cost-effectiveness and necessity of routine testing for healthy pediatric patients.
Purpose of the Study:
- To evaluate the necessity of routine preoperative laboratory tests in healthy pediatric patients undergoing minor, same-day surgical procedures.
- To compare outcomes between patients who received routine tests versus selected tests based on clinical indications.
Main Methods:
- Retrospective chart review of 10,656 children (ASA physical status 1 and 2) undergoing minor surgery over 15 years.
- Group A (1884 patients): Routine preoperative laboratory tests.
- Group B (8772 patients): Selected preoperative laboratory tests based on clinical assessment.
Main Results:
- No significant difference in major or minor complications between groups.
- Selected laboratory testing (Group B) did not compromise patient safety or quality of care.
- Routine testing (Group A) incurred unnecessary costs.
Conclusions:
- Clinical assessment alone is adequate for preoperative evaluation of healthy pediatric patients for same-day surgery.
- Selective laboratory testing, guided by clinical findings, is cost-effective and safe.
- Eliminating routine preoperative lab tests reduces healthcare costs without compromising patient outcomes.
Abstract:
Since 1984, laboratory tests have not been routinely required for healthy paediatric patients scheduled for one-day surgery in our Paediatric Surgery Department. We reviewed the medical charts of all children ASA physical status 1 and 2 who underwent a minor surgical procedure in the last 15 years. We excluded all former preterm infants of less than 60 weeks postconceptual age. The series under examination includes two groups of patients: group A includes 1884 children who underwent routine preoperative laboratory tests; group B includes 8772 children who had preoperative, selected laboratory tests performed only when the child's history and/or clinical examination revealed some abnormalities. The following data were collected: demographic data, ASA physical status classification, surgical procedure, anaesthetic technique, major and minor complications, length of hospital stay, the difference between the expected length of hospitalization and the actual length, number and reasons for cancellations of surgery. On the basis of our experience we believe that a thorough clinical assessment of the patient is more important than routine preoperative laboratory screening, which should be required only when justified by real clinical indications. Moreover, this practice eliminates unnecessary costs without compromising the safety and the quality of care.