Assessment of Routine Preoperative Laboratory Testing Practice among Elective Surgical Patients at a Tertiary Care Institution, Addis Ababa, Ethiopia: A Retrospective Study

Abstract

Introduction: There are over 90,000 major elective surgeries performed each year in Ethiopia. Obtaining routine or baseline preoperative laboratory tests increases healthcare costs. Preoperative testing should be based on clear guiding principles. Hence, tests should be done only if results are likely to affect patient management and postoperative outcome. Aim: To assess routine preoperative laboratory testing practice in patients who underwent elective surgery in a resource-limited setup at a tertiary care institution, Addis Ababa, Ethiopia. Materials and Methods: The study was conducted at St. Paul’s Hospital Millennium Medical College (SPHMMC), which is located in Addis Ababa, Ethiopia. A retrospective observational study of medical records was done with proportional sampling among preoperative elective surgical patients of different disciplines from March 2019 to May 2019 to assess the practice of preoperative laboratory testing, appropriateness of use and implied extra cost in comparison with the National Institute for Health and Clinical Excellence (NICE) guidelines. Results: Total 353 patients were subjected to a 1567 test. About 643 (41%) of all tests were not indicated and 27 (4.2%) of these had unexpected abnormal results. The change in decision rate from unindicated tests were 29.6%. The total deviation rate from National Institute for Health and Care Excellence (NICE) Guideline was 26.5%. The proportion of tests done which conformed to the guidelines (58.9%) were significantly lower than the proportion of test not done but conformed (p-value <0.001). The extra cost incurred was 71.5% of the total cost for the tests. Conclusion: The proportions of tests with expected abnormal results, unexpected abnormal results, and subsequent changes in the decision was low, which underlines the essence of a guideline that takes into account population characteristics.

Keywords

• guidelines
• healthcare costs
• health resources
• indicated tests
• postoperative period
• screening