AI Article Synopsis
- - The study aimed to evaluate the necessity of preoperative testing in patients classified as ASA physical status 1 and 2 who were undergoing outpatient surgeries, using data from the American College of Surgeons National Surgical Quality Improvement Program for 2017-2018.
- - Among 352,775 patients, 186,954 (53%) had at least one lab test prior to surgery, with hematology tests being the most common; however, preoperative testing did not significantly reduce medical or surgical complications post-surgery.
- - The findings suggest that preoperative laboratory tests for ASA 1 and 2 patients have low utility and support considering their elimination for various outpatient procedures.
Article Abstract
Study Objective: To assess the utility of preoperative testing in ASA physical status 1 and 2 patients undergoing outpatient surgery across several surgical specialties.
Design: Retrospective cohort study.
Patients: The American College of Surgeons National Surgical Quality Improvement Program database from 2017 to 2018 was queried to extract patients defined as ASA 1 and 2 who underwent outpatient surgeries. A total of 352,775 adult patients underwent outpatient surgery with 186,954 patients had at least one lab drawn within 30 days prior to the surgery.
Interventions: ASA physical status 1 and 2 patients who underwent outpatient surgeries.
Measurements: The primary independent variable was the utilization of preoperative laboratory testing. The primary outcomes were the occurrence of any medical or surgical complication adverse events within 30 days of discharge. In addition, we also examined hospital readmissions. A P value of 0.025 was used to avoid type I error for each primary outcome.
Main Results: In the overall cohort, 186,954 out of 352,775 (53%) of patients had at least one lab test. Hematology was the most common lab test ordered, 172,903 out of 352,755 patients (49%), followed by chemistry (43%), liver function (23%), and coagulation tests (11%). After adjusting for confounding factors, the use preoperative testing was not associated with overall medical complications, OR (95%CI) of 1.09 (1.00 to 1.18), P = 0.05 and overall surgical complications, 1.00 (0.92 to 1.08), P = 0.96 [Bonferroni corrected: medical complications OR (97.5% CI) of 1.09 (0.989 to 1.202), P = 0.0950 and overall surgical complications, 1.00 (0.918 to 1.093), P = 1.00.
Conclusion: We detected a low utility of preoperative tests for ASA 1 and 2 patients undergoing a large variety of outpatient procedures. Our results support the elimination of preoperative laboratory test for ASA 1 and 2 undergoing ambulatory surgery.
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| http://dx.doi.org/10.1016/j.jclinane.2021.110580 | DOI Listing |
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