Objectives Routine preoperative examinations for elective surgical procedures are an integral part of preoperative anaesthetic assessment and patient optimization. The existence of relevant guidelines for healthcare professionals (NICE guideline, NG45) aims to avoid overtesting which is associated with increased levels of patients’ stress, increased health care cost, waste of staff, resources and infrastructure, as well as delays, postponements or surgery cancellations. The aim of our study is to record the policy of routine preoperative examinations for elective surgery and to conduct a cost evaluation in four public hospitals in Greece.
Method This is a one-year multicenter observational study. Data were obtained from four public hospitals in Greece; two general and two cancer treatment. Participating hospitals were able to choose from three different time periods (2018–2019, 2019–2020 or 2021–2022). A standardized collection form was used for data collection and analysis. Exclusion criteria included age under 18 years old, non-elective surgery, obstetric, cardiothoracic surgery, and neurosurgery. All eligible participants were clinically assessed in the outpatient pre-anaesthetic clinic and preoperative laboratory and imaging tests were ordered by both surgeons and anaesthesiologists. Expert counseling was provided in each case deemed appropriate. Special examinations outside the scope of the standard preoperative testing, as well as working hours of the medical staff involved were not included in cost calculation.
Results Routine preoperative tests were recorded for 13,199 individuals scheduled for elective surgery. In most cases, attending surgeons and anaesthesiologists were laboratory oriented; routine laboratory and imaging tests preceded pre-anaesthetic evaluation and physical examination. In these cases, preoperative tests were not adjusted to ASA physical status and surgery grade (minor, intermediate, major or complex surgery). Instead, tests were ordered by the attending surgeon according to the clinic’s predefined list. Additional tests were ordered by the Anaesthesiologists during the preoperative examination whenever needed. Large discrepancies were detected between different clinics of all participating hospitals in terms of examinations ordered, ranging from 14 to 36 examinations per patient with a corresponding cost ranging from 48,98 to 204.22 euros per patient. Annual cost ranged from 280,417 to 639,087 euros per hospital.
Conclusions We undertook this observational study in order to examine the management and the cost of routine preoperative laboratory tests in four public hospitals in Greece. In all participating hospitals, routine preoperative tests were ordered according to a predefined list. Laboratory examination preceded the preoperative anaesthetic examination, and though this may seem time-saving, it has unknown implications in cost of the preoperative preparation, as well as on patient outcome. Whether the use of a predefined list for routine preoperative examinations results in less time-consuming policies and augments patients’ satisfaction with minimal burden on preoperative cost remains to be investigated in larger well structured trials.
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