Routine Preoperative Evaluation in Surgical Patient

Aga Khan University

Status: Completed

Conditions: Orthopedic Disorder

Treatments: Other: preoperative blood tests

Study type: Observational

Funder types: Other

Identifiers

NCT04196166

4226-Sur-ERC-16

Details and patient eligibility

About

The "routine" pre-operative tests in healthy orthopaedic patients undergoing intermediate/ major surgery are not justified. In this study of 670 healthy orthopedic patients with 7610 preoperative tests, investigators found that surgical plan was influenced in <1% of patients. Surgeons should be sensitized to reconsider this practice particularly with limited resources.

Full description

Background: Routine preoperative tests in healthy patients not only cause extra anxiety, but may delay treatment without influencing surgical plan. This has worse impact in resource-constrained settings where fee for service rather than health insurance is the usual norm. Investigators aim to determine if "routine" pre-operative tests are justified in healthy orthopedic patients.

Methods: Investigators conducted a non-commercialized, non-funded matched case control study in tertiary care university hospital and a level-1 trauma centre for healthy patients (ASA-1&2) admitted from January 2014-December 2016 for elective orthopedic intermediate and major procedures. Cases (patient who had a change in his/her surgical plan after admission) and controls were selected independently of the exposure of interest then matched randomly to cases on age, gender and procedure type. Primary exposure was the routine preoperative lab tests, as defined by the American Society of Anesthesiologist, which included 13 blood tests. Analysis was done using Principle Component Analysis and Conditional logistic regression at univariate and multivariable levels reporting matched adjusted Odds Ratios. The data will bereported in line with STROBE criteria.

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Enrollment: 1,000 patients

Sex: All

Ages: 1 to 100 years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

• Participants irrespective of age and gender.
• ASA-1 and ASA-2 status.
• Primary elective orthopedic procedures.
• Blood lab tests done at the institution only.

Exclusion criteria

• Ambulatory care procedures
• Revision surgery.
• Participants admitted to other services, high care or intensive care units.

Trial design

1,000 participants in 2 patient groups

Cases

Description:

nested from on going retrospective cohort study. Participants who had change in their surgical plan after hospitalization.

Treatment:

Other: preoperative blood tests

Controls

Description:

nested from on going retrospective cohort study. Participants who didn't have change in their surgical plan after hospitalization.

Treatment:

Other: preoperative blood tests