Preoperative laboratory testing in patients undergoing elective, low-risk ambulatory surgery

Jaime Benarroch-Gampel, Kristin M. Sheffield, Casey B. Duncan, Kimberly M. Brown, Yimei Han, Courtney Townsend, Taylor S. Riall

Research output: Contribution to journalArticle

75 Citations (Scopus)

Abstract

Background: Routine preoperative laboratory testing for ambulatory surgery is not recommended. Methods: Patients who underwent elective hernia repair (N = 73,596) were identified from the National Surgical Quality Improvement Program (NSQIP) database (2005-2010). Patterns of preoperative testing were examined. Multivariate analyses were used to identify factors associated with testing and postoperative complications. Results: A total of 46,977 (63.8%) patients underwent testing, with at least one abnormal test recorded in 61.6% of patients. In patients with no NSQIP comorbidities (N = 25,149) and no clear indication for testing, 54% received at least one test. In addition, 15.3% of tested patients underwent laboratory testing the day of the operation. In this group, surgery was done despite abnormal results in 61.6% of same day tests. In multivariate analyses, testing was associated with older age, ASA (American Society of Anesthesiologists) class >1, hypertension, ascites, bleeding disorders, systemic steroids, and laparoscopic procedures. Major complications (reintubation, pulmonary embolus, stroke, renal failure, coma, cardiac arrest, myocardial infarction, septic shock, bleeding, or death) occurred in 0.3% of patients. After adjusting for patient and procedure characteristics, neither testing nor abnormal results were associated with postoperative complications. Conclusions: Preoperative testing is overused in patients undergoing low-risk, ambulatory surgery. Neither testing nor abnormal results were associated with postoperative outcomes. On the basis of high rates of testing in healthy patients, physician and/or facility preference and not only patient condition currently dictate use. Involvement from surgical societies is necessary to establish guidelines for preoperative testing.

Original languageEnglish (US)
Pages (from-to)518-528
Number of pages11
JournalAnnals of Surgery
Volume256
Issue number3
DOIs
StatePublished - Sep 2012

Fingerprint

Ambulatory Surgical Procedures
Quality Improvement
Multivariate Analysis
Hemorrhage
Herniorrhaphy
Coma
Septic Shock
Heart Arrest
Embolism
Ascites
Renal Insufficiency
Comorbidity
Stroke
Steroids
Myocardial Infarction
Databases
Guidelines
Hypertension
Physicians
Lung

Keywords

  • ambulatory surgery
  • low-risk surgery
  • overuse
  • preoperative evaluation
  • preoperative laboratory testing

ASJC Scopus subject areas

  • Surgery

Cite this

Benarroch-Gampel, J., Sheffield, K. M., Duncan, C. B., Brown, K. M., Han, Y., Townsend, C., & Riall, T. S. (2012). Preoperative laboratory testing in patients undergoing elective, low-risk ambulatory surgery. Annals of Surgery, 256(3), 518-528. https://doi.org/10.1097/SLA.0b013e318265bcdb

Preoperative laboratory testing in patients undergoing elective, low-risk ambulatory surgery. / Benarroch-Gampel, Jaime; Sheffield, Kristin M.; Duncan, Casey B.; Brown, Kimberly M.; Han, Yimei; Townsend, Courtney; Riall, Taylor S.

In: Annals of Surgery, Vol. 256, No. 3, 09.2012, p. 518-528.

Research output: Contribution to journalArticle

Benarroch-Gampel, J, Sheffield, KM, Duncan, CB, Brown, KM, Han, Y, Townsend, C & Riall, TS 2012, 'Preoperative laboratory testing in patients undergoing elective, low-risk ambulatory surgery', Annals of Surgery, vol. 256, no. 3, pp. 518-528. https://doi.org/10.1097/SLA.0b013e318265bcdb
Benarroch-Gampel, Jaime ; Sheffield, Kristin M. ; Duncan, Casey B. ; Brown, Kimberly M. ; Han, Yimei ; Townsend, Courtney ; Riall, Taylor S. / Preoperative laboratory testing in patients undergoing elective, low-risk ambulatory surgery. In: Annals of Surgery. 2012 ; Vol. 256, No. 3. pp. 518-528.
@article{01e6db2feb9b4fb7b67cc97dced850df,
title = "Preoperative laboratory testing in patients undergoing elective, low-risk ambulatory surgery",
abstract = "Background: Routine preoperative laboratory testing for ambulatory surgery is not recommended. Methods: Patients who underwent elective hernia repair (N = 73,596) were identified from the National Surgical Quality Improvement Program (NSQIP) database (2005-2010). Patterns of preoperative testing were examined. Multivariate analyses were used to identify factors associated with testing and postoperative complications. Results: A total of 46,977 (63.8{\%}) patients underwent testing, with at least one abnormal test recorded in 61.6{\%} of patients. In patients with no NSQIP comorbidities (N = 25,149) and no clear indication for testing, 54{\%} received at least one test. In addition, 15.3{\%} of tested patients underwent laboratory testing the day of the operation. In this group, surgery was done despite abnormal results in 61.6{\%} of same day tests. In multivariate analyses, testing was associated with older age, ASA (American Society of Anesthesiologists) class >1, hypertension, ascites, bleeding disorders, systemic steroids, and laparoscopic procedures. Major complications (reintubation, pulmonary embolus, stroke, renal failure, coma, cardiac arrest, myocardial infarction, septic shock, bleeding, or death) occurred in 0.3{\%} of patients. After adjusting for patient and procedure characteristics, neither testing nor abnormal results were associated with postoperative complications. Conclusions: Preoperative testing is overused in patients undergoing low-risk, ambulatory surgery. Neither testing nor abnormal results were associated with postoperative outcomes. On the basis of high rates of testing in healthy patients, physician and/or facility preference and not only patient condition currently dictate use. Involvement from surgical societies is necessary to establish guidelines for preoperative testing.",
keywords = "ambulatory surgery, low-risk surgery, overuse, preoperative evaluation, preoperative laboratory testing",
author = "Jaime Benarroch-Gampel and Sheffield, {Kristin M.} and Duncan, {Casey B.} and Brown, {Kimberly M.} and Yimei Han and Courtney Townsend and Riall, {Taylor S.}",
year = "2012",
month = "9",
doi = "10.1097/SLA.0b013e318265bcdb",
language = "English (US)",
volume = "256",
pages = "518--528",
journal = "Annals of Surgery",
issn = "0003-4932",
publisher = "Lippincott Williams and Wilkins",
number = "3",

}

TY - JOUR

T1 - Preoperative laboratory testing in patients undergoing elective, low-risk ambulatory surgery

AU - Benarroch-Gampel, Jaime

AU - Sheffield, Kristin M.

AU - Duncan, Casey B.

AU - Brown, Kimberly M.

AU - Han, Yimei

AU - Townsend, Courtney

AU - Riall, Taylor S.

PY - 2012/9

Y1 - 2012/9

N2 - Background: Routine preoperative laboratory testing for ambulatory surgery is not recommended. Methods: Patients who underwent elective hernia repair (N = 73,596) were identified from the National Surgical Quality Improvement Program (NSQIP) database (2005-2010). Patterns of preoperative testing were examined. Multivariate analyses were used to identify factors associated with testing and postoperative complications. Results: A total of 46,977 (63.8%) patients underwent testing, with at least one abnormal test recorded in 61.6% of patients. In patients with no NSQIP comorbidities (N = 25,149) and no clear indication for testing, 54% received at least one test. In addition, 15.3% of tested patients underwent laboratory testing the day of the operation. In this group, surgery was done despite abnormal results in 61.6% of same day tests. In multivariate analyses, testing was associated with older age, ASA (American Society of Anesthesiologists) class >1, hypertension, ascites, bleeding disorders, systemic steroids, and laparoscopic procedures. Major complications (reintubation, pulmonary embolus, stroke, renal failure, coma, cardiac arrest, myocardial infarction, septic shock, bleeding, or death) occurred in 0.3% of patients. After adjusting for patient and procedure characteristics, neither testing nor abnormal results were associated with postoperative complications. Conclusions: Preoperative testing is overused in patients undergoing low-risk, ambulatory surgery. Neither testing nor abnormal results were associated with postoperative outcomes. On the basis of high rates of testing in healthy patients, physician and/or facility preference and not only patient condition currently dictate use. Involvement from surgical societies is necessary to establish guidelines for preoperative testing.

AB - Background: Routine preoperative laboratory testing for ambulatory surgery is not recommended. Methods: Patients who underwent elective hernia repair (N = 73,596) were identified from the National Surgical Quality Improvement Program (NSQIP) database (2005-2010). Patterns of preoperative testing were examined. Multivariate analyses were used to identify factors associated with testing and postoperative complications. Results: A total of 46,977 (63.8%) patients underwent testing, with at least one abnormal test recorded in 61.6% of patients. In patients with no NSQIP comorbidities (N = 25,149) and no clear indication for testing, 54% received at least one test. In addition, 15.3% of tested patients underwent laboratory testing the day of the operation. In this group, surgery was done despite abnormal results in 61.6% of same day tests. In multivariate analyses, testing was associated with older age, ASA (American Society of Anesthesiologists) class >1, hypertension, ascites, bleeding disorders, systemic steroids, and laparoscopic procedures. Major complications (reintubation, pulmonary embolus, stroke, renal failure, coma, cardiac arrest, myocardial infarction, septic shock, bleeding, or death) occurred in 0.3% of patients. After adjusting for patient and procedure characteristics, neither testing nor abnormal results were associated with postoperative complications. Conclusions: Preoperative testing is overused in patients undergoing low-risk, ambulatory surgery. Neither testing nor abnormal results were associated with postoperative outcomes. On the basis of high rates of testing in healthy patients, physician and/or facility preference and not only patient condition currently dictate use. Involvement from surgical societies is necessary to establish guidelines for preoperative testing.

KW - ambulatory surgery

KW - low-risk surgery

KW - overuse

KW - preoperative evaluation

KW - preoperative laboratory testing

UR - http://www.scopus.com/inward/record.url?scp=84865450320&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84865450320&partnerID=8YFLogxK

U2 - 10.1097/SLA.0b013e318265bcdb

DO - 10.1097/SLA.0b013e318265bcdb

M3 - Article

C2 - 22868362

AN - SCOPUS:84865450320

VL - 256

SP - 518

EP - 528

JO - Annals of Surgery

JF - Annals of Surgery

SN - 0003-4932

IS - 3

ER -