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

79 Scopus citations

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

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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