Indication of preoperative tests according to clinical criteria: need for supervision

Abstract

Background and objectives: The indiscriminate order for additional tests on pre-anesthetic evaluation is common in clinical practice, which entails additional costs and the possibility of false-positive results. The aim of this study was to analyze whether preoperative tests in elective surgeries are ordered according to clinical criteria and assess the unnecessary costs for the institution. Methods: Evaluation of preoperative investigations in adult patients undergoing elective non-cardiac surgery. Tests were ordered by surgeons according to the Anesthesia Service protocol. Demographic data, physical status, comorbidities, and type of ordered supplementary examination were evaluated. The tests performed were compared with the indicated tests. The cost of screening was based on Datasus’ table. Results: 1063 patients were evaluated. It was found that 41.9% of the tests performed on patients classified as ASA-I were not indicated. In ASA II group, 442 tests (17.72%) were made unnecessarily. The ordered percentages of blood count, creatinine, coagulation profile, chest X-ray, and ECG were high in groups ASA I–II. Only 40 (5.25%) of the examinations made in ASA III group were not indicated. In ASA IV group, 22.5% of the required tests were not performed. We highlight an annual saving of 13% (R$ 1923.13) if tests were done according to the protocol. Conclusions: Preoperative tests are not always ordered according to clinical criteria, which results in higher costs for the institution. Keywords: Medical examinations, Assessment in health care, Hospital costs