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Preoperative Laboratory Testing in Patients Undergoing Elective, Low-Risk Ambulatory Surgery
Jaime Benarroch-Gampel*, Kristin M Sheffiled*, Casey A Boyd*, Kimberly M Brown*, Yimei Han*, Courtney M Townsend, Jr., Taylor S Riall*
University of Texas Medical Branch, Galveston, TX

OBJECTIVES: To evaluate the use of preoperative laboratory testing in ambulatory surgery.
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 testing were examined. Multivariate analyses were used to identify factors associated with individual tests and postop complications.
RESULTS: 46,977 (64%) patients underwent testing, with at least one abnormal result recorded in 44% of patients. 15% of patients underwent testing the day of surgery. Surgery was done despite abnormal results in 40% of same day tests. In patients with no NSQIP comorbidities (N=25,149), 54% underwent at least one test (specific tests in Table 1). In multivariate analyses, preoperative testing was associated with older age, ASA class >1, general anesthesia, hypertension, ascites, bleeding disorders, steroid use, and laparoscopic procedures for each test. Major complications occurred in 0.3% of patients (reintubation, pulmonary embolus, stroke, renal failure, coma, major cardiac, septic shock, bleeding, or death). After adjusting for patient and procedure characteristics, neither testing nor abnormal results were associated with postop complications.
CONCLUSIONS: Preoperative testing in ambulatory surgery is overused. Use of testing and abnormal results were not associated with adverse outcomes. Based on high rates of testing in healthy patients, physician and/or facility preferences appear to dictate a significant portion of test use. Involvement from surgical societies is necessary to establish guidelines for testing.
Percentage of Patients Undergoing Specific Preoperative Tests
Overall Cohort (N=73,596)Patients with No Comorbidities (N=25,149)
Any Test64%54%
Complete blood count59%52%
Coagulation profile19%15%
Liver function tests24%20%

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