Abstract :
Introduction: During the past decades, practice of routine investigations prior to surgery has been
challenged as it has little impact on perioperative management but increases cost, causes delay and increases
laboratory load. We aimed to prospectively assess the influence of pre-operative investigations on resource
utilisation and peri-operative management in elective surgeries.
Materials and Methods: Prospective observational study was done in 500 Patients, who attended preanaesthetic
check-up (PAC) for elective surgeries. Number of investigation already performed before
arriving in PAC and their results in terms of normal and abnormal tests were noted. Based on National
Institute for Health and Care Excellence (NICE) guideline, the test was considered as indicated or
unindicated. These patients were then followed up till the post-operative period and any referral, further
investigation or delay done during pre-operative was noted. An abnormal test result was said to be impactful
if it resulted in referral, delay or further investigations. Cost analysis was done for every test that was
considered not necessary based on NICE guidelines.
Results: Majority (60.6%) of the patients had at least one abnormal test results on routine pre-operative
tests, but only 6.93% of all tests performed had any impact in terms of referral, further testing or delay.
Only 5 (0.14%) of all 3462 abnormal test had significant impact which it lead to change in perioperative
management.
Conclusion: The practice of prescribing large number of routine pre-operative investigations is prevalent
in the institution. Most of the investigations are done without following any guidelines, which leads to
wastage of resources.
Keyword :
Routine laboratory testing, Preoperative investigations, NICE guidelines, Peri Operative anesthesia
management.