Depending on which facility patients go to for their low-risk surgical procedure, they may be 2.4 times more or less likely to be sent for unnecessary blood tests. This finding is among those from a study conducted by researchers from the Institute of Clinical Evaluative Sciences (ICES) and the Women’s College Hospital Institute for Health Systems Solutions and Virtual Care (WIHV), both in Toronto, Ontario, Canada.
Published in Anesthesiology, the study reviewed anonymized patient records for nearly 1 million adults who underwent ophthalmologic surgery or other low-risk surgical procedures in 2008-2013. Researchers found that overall, preoperative laboratory tests, including complete blood count (CBC), blood clotting test, or basic metabolic panel, were conducted prior to roughly 30% of these procedures. In addition, they found high variability in rates among the 119 institutions studied.
Previous studies have shown that for patients undergoing low-risk surgery, routine preoperative blood tests do not improve outcomes and can lead to surgical delays and negative impacts on patient care. As part of the Choosing Wisely campaign, multiple Canadian and American specialty societies, including the Canadian and American societies of anesthesiologists, the American Society for Clinical Pathology, and the American and Canadian surgical societies, have published recommendations stating that unless a patient has clinical indications, preoperative lab tests should be avoided prior to low-risk surgeries.
“Unnecessary but frequently used healthcare interventions like preoperative lab tests represent a significant cost to our already overburdened health care system and can even expose patients to harm,” says the study’s lead author Sacha Bhatia, MD, MBA, FRCPC, Women’s College Hospital cardiologist, director of WIHV, and a scientist at ICES. “For example, these tests can lead to surgical delays and more follow-up tests and interventions, which can cause a lot of stress and anxiety for patients and their families. This is despite evidence that these tests do not support better patient care or health outcomes.”
Among the study’s key findings:
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The most common preoperative blood tests were the basic metabolic panel and CBC, each performed before 25% of procedures. Additionally, blood clotting tests were conducted prior to 5% of the procedures.
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Throughout the five-year study period, the rate of preoperative laboratory tests overall decreased from just more than 30% to just less than 28%.
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There was wide institutional variability in the use of these tests. For CBC tests, one institution showed a rate of 0%, whereas another showed a rate of 98%.
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Patients age 85 or older were three times more likely to undergo these tests, compared to 18- to 25-year-olds.
This study is the first to examine preop lab rates for a broad range of low-risk procedures in multiple institutions across a large patient population and district, and over multiple years. “We see wide variability between hospitals in the rates of unnecessary lab tests for patients undergoing low-risk surgical procedures,” says Bhatia. To read the abstract, go to bit.ly/1KIgvLS.
