Preoperative procedures preceding a patient’s surgery require a patient to arrive hours before their surgery. But how effective are pre-anesthetic tests? Routine pre-anesthetic tests cost more than $60 billion every year and studies dating back to 1985 offer evidence that these tests may incur unnecessary costs and that they may be adding unintended harms.
Nursing Link’s historical perspective of pre-anesthetic assessment looked at study done in the late 1980’s of the laboratory screening of 2,000 patients that included complete and differential blood cell counts, prothrombin time and partial prothrombin time, platelet counts, six- factor automated multiple analysis, and glucose level tests. Sixty percent of the tests ordered “would not have been performed if testing had only been done for recognizable indications.” Furthermore, only 0.22% of these tests revealed abnormalities, abnormalities that were not acted upon and did not cause any adverse anesthetic consequences. A more recent study indicates that postoperative complications were strongly associated with only the type of anesthesia and procedure and that the only tests that may have a link to postoperative complications are the EKG, chest X-ray and nutritional status tests.
According to a SurgiStrategies article titled “Anesthesiology: An Evolution in Safety,” about 1 in 10,000 relatively healthy patients died within 24 hours of an anesthetic and surgical procedure in 1970. That risk decreased at least 25-fold (to at least 1 in 250,000) in the following 40 years. The dramatic development in medical equipment and anesthetic efficiency and safety has led to these improvements. Given the safety of current anesthesia practices and relative inefficiency of pre-anesthetic tests, it seems nonsensical to pump such pointless costs into preoperative tests.
These tests may also lead to indirect and initially unnoticeable consequences as well. For example, these tests may lead to false positive results and iatrogenic diseases, which can impact patients not only through pointless treatments and costs, but also through further invasive testing and dangerous health implications.
Instead of pursuing seemingly inefficient preoperative tests that may lead to unintended harm and frivolous spending, anesthesiologists and other anesthesia-practicing physicians should look to cut the unnecessary components of preoperative procedures. By doing so, medicolegal risks and costs can be reduced substantially and practice efficiency can improve.
The right anesthesia partner can help your hospital evaluate the entire perioperative process and build efficiencies around it. For more information, download Somnia’s white paper titled, “Creating A Perioperative Partnership for Operating Room Managers”