The role of pre-operative investigations in relatively healthy general surgical patients- a retrospective study

Background: Pre-operative testing has been criticized as having little impact on peri-operative outcomes. The aim of this study was to establish the number of unnecessary pre-operative investigations undertaken in American Society of Anesthesiologists (ASA ) Grade I patients undergoing general surgery. Methodology: The clinical record of 1200 patients, who underwent surgery in a period of 6 months from June 2012 to December 2012, were screened, out of which record of 500 ASA-I patients, aged 15-50 years, undergoing cholecystectomy and hernia repair were reviewed. Pre-operative investigations were assessed in terms of frequency of use and abnormalities detected. It was also checked whether the abnormal results altered the patient’s management. The peri-operative complications if any were noted and their co-relation to the investigations was established. The total cost of investigations was calculated. Result: All 100% of the patients had had preoperative tests for hemoglobin, total leucocyte count, differential leucocyte count, urine routine examination, random blood sugar and blood urea levels. Platelet count was done in 90%, serum creatinine in 50%, liver function tests in 55%, x-ray chest in 94% and electrocardiogram in 84% of the patients. No change in the plan of anesthesia was made in any of these cases. 7.5% of the patients required some intra-operative or post-operative intervention. The total cost of processing the requested investigations as per the list provided by the Central Government Health Services (CGHS) was Rs 3,62,125 or IRs. 724.25 per patient. Conclusion: We conclude that routine pre-operative investigations are unnecessary in ASA Grade-I patients undergoing low to moderate risk general surgery. There is a need to have guidelines for indicated tests in different groups of diseases and procedures, to be ordered by the anesthesiologists to prevent unnecessary wastage of time, money, and resources and to avoid overburdening laboratory staff.