The appropriateness of preoperative blood testing: A retrospective evaluation and cost analysis
South African Medical Journal
Department of Anaesthesiology and Critical Care, School of Clinical Medicine, College of Health Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa; Perioperative Research Group, Department of Anaesthetics and Critical Care, School of Clinical Medicine, College of Health Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa; Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, United States
Background. Inappropriate preoperative blood testing can negatively contribute to healthcare costs. Objective. To determine the extent and cost implications of inappropriate preoperative blood testing in adult patients booked for orthopaedic, general or trauma surgical procedures at a regional hospital in KwaZulu-Natal Province, South Africa (SA). Methods. We undertook a retrospective observational study using routine clinical data collected from eligible patient charts. The appropriateness of preoperative blood tests was evaluated against locally published guidelines on testing for elective and non-elective surgery. The cost of the relevant blood tests was determined using the National Health Laboratory Service 2014 State Pricing List. Results. A total of 320 eligible patient charts were reviewed over a 4-week period. Preoperative blood testing was performed in 318 patients. There was poor compliance with current departmental guidelines, with an estimated over-expenditure of ZAR81 019. Non-compliance was particularly prevalent in younger patients, patients graded as American Society of Anesthesiologists 1 and 2, and low-risk surgery groups. Conclusion. Inappropriate preoperative blood testing is common in our hospital, particularly in low-risk patients. This is associated with an increase in healthcare costs, and highlights the need for SA doctors to become more cost-conscious in their approach to blood testing practices. © 2015, South African Medical Association. All rights reserved.
albumin; C reactive protein; calcium; creatinine; electrolyte; magnesium; phosphate; urea; adult; aged; Article; blood cell count; blood examination; blood gas analysis; comorbidity; cost benefit analysis; erythrocyte sedimentation rate; human; international normalized ratio; liver function test; major clinical study; middle aged; observational study; preoperative evaluation; retrospective study; South Africa; surgical technique