Arvidsson S, Bjork L, Brorsson B, Haglund U, Jorfeldt L, Lundberg D, Norlund A
Record ID 31995000044
To assess the value of different preoperative investigations including preoperative chest radiography, electrocardiographic examination and clinical laboratory tests based on evidence in the medical literature. Secondly, to describe the current practice in Sweden for routine investigations prior to elective surgery.
Authors' results and conclusions:
The literature search revealed no well controlled study that verified the benefit of preoperative investigation of healthy patients without previous history of illness. Several studies demonstrated benefits from performing preoperative chest radiography, electrocardiograms, and clinical laboratory tests on patients in high risk categories. The survey (93% response) showed that the use of and selection criteria for preoperative investigations vary significantly in Sweden. The cost of preoperative investigations in Sweden is SEK 726 million, including one inpatient day in 75% of all surgical cases. Using more restrictive criteria for preoperative investigations, the potential savings are calculated as SEK 100-200 million per year (equivalent to about US $3 million per million population).
The following recommendations are made for healthy patients without complications. The basis for preoperative investigation should be a thorough history and careful physical examination of the patient. Chest radiography should not be used as a routine examination. Routine electrocardiographic testing and clinical laboratory tests should not be performed unless specifically indicated. The attending anaesthesiologist should examine and interview all patients prior to surgery. Certain organisational changes will be necessary to implement these recommendations.
Other output or dissemination activity: A survey of seven hospitals was conducted on four occasions: before the report was published in 1989, in 1990, 1991 and 1994. All surgery patients from general surgery, orthopaedics and gynaecology and for whom an anaesthesia case record was kept were included for a total of 3000 patients. Between the 1989 and 1994 surveys, there was a 9% decrease in the number of preoperative chest x-rays, and 11% decrease in the number of preoperative ECGs, a 16% decrease in the number of routine S-potassium laboratory tests taken and a 14% increase in the number of same day admissions for surgery.
English language abstract:
An English language summary is available
- Diagnostic Tests, Routine
- Hematologic Tests
- Preoperative Care
Swedish Agency for Health Technology Assessment and Assessment of Social Services
P.O. Box 3657, SE-103 59 Stockholm, Sweden. Tel: +46 8 4123200, Fax: +46 8 4113260
The Swedish Council on Technology Assessment in Health Care