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June 28, 1985, Vol 253, No. 24 >
ARTICLE | June 28, 1985

The Usefulness of Preoperative Laboratory Screening FREE

Eric B. Kaplan, MD; Lewis B. Sheiner, MD; Alison J. Boeckmann, MS; Michael F. Roizen, MD; Stuart L. Beal, PhD; Stephen N. Cohen, MD; C. Diana Nicoll, MD, PhD
[+] Author Affiliations

Reprint requests to Department of Laboratory Medicine, M-523, University of California, San Francisco, San Francisco, CA 94143 (Dr Sheiner).


JAMA. 1985;253(24):3576-3581. doi:10.1001/jama.1985.03350480084025
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References

We assessed the usefulness of routine laboratory screening of preoperative patients. Computer-readable laboratory, demographic, and discharge diagnostic data were assembled for 2,000 patients undergoing elective surgery over a four-month period, and randomly selected samples of patients were studied. Several tests ordered by protocol and performed by the laboratory at the time of admission were examined in these samples, including complete blood cell count, differential cell count, prothrombin time, partial thromboplastin time, platelet count, six-factor automated multiple analysis, and glucose level.

Sixty percent of these routinely ordered tests would not have been performed if testing had only been done for recognizable indications, and only 0.22% of these revealed abnormalities that might influence perioperative management. Chart review indicated that these few abnormalities were not acted on nor did they have adverse surgical or anesthetic consequences. In the absence of specific indications, routine preoperative laboratory tests contribute little to patient care and could reasonably be eliminated.

(JAMA 1985;253:3576-3581)

REFERENCES

1 +
Ashley JSA, Parker P, Beresford TC:  How much clinical investigation? Lancet 1972;;1:890-892.
2 +
Carmalt MHB, Whitehead TP:  Biochemical profiles and length of hospital stay . Proc R Soc Med 1971;;64:257-259.
3 +
Korvin CC, Pearce RH, Stanley J:  Admissions screening: Clinical benefits . Ann Intern Med 1975;;83:197-203.
4 +
Martin SP, Donaldson MC, London CD, et al:  Inputs into coronary care during 30 years: A cost effectiveness study . Ann Intern Med 1974;; 81:289-293.
5 +
Griner PF:  Treatment of acute pulmonary edema: Conventional or intensive care? Ann Intern Med 1972;;77:501-506.
6 +
Myers LP, Schroeder SA:  Physician use of services for the hospitalized patient: A review, with implications for cost containment . Milbank Mem Fund Q 1981;;59:481-487.
7 +
Griner PF, Liptzin B:  Use of the laboratory in a teaching hospital: Implications for patient care, education, and hospital costs . Ann Intern Med 1971;;75:157-163.
8 +
Bold AM, Corrin B:  Use and abuse of clinical chemistry in surgery . Br Med J 1965;; 2:1051-1052.
9 +
Eisenberg M, Williams SV, Garner L, et al:  Computer-based audit to detect and correct overutilization of laboratory tests . Med Care 1977;;15:915-921.
10 +
Druckman E (ed):  Do doctors order too many tests? CAHP Newsletter 1979;;3:1.
11 +
Jacobson KW, Branch LB, Nelson HS:  Laboratory tests in chronic urticaria . JAMA 1980;;243:1644-1646.
12 +
Abrams HL:  The overutilization of x-rays . N Engl J Med 1979;;300:1213-1216.
13 +
Schroeder SA, Schliftman A, Piemme TE:  Variation among physicians in use of laboratory tests: Relation to quality of care . Med Care 1974;;12:709-713.
14 +
Daniels M, Schroeder SA:  Variation among physicians in use of laboratory tests: II. Relation to clinical productivity and outcomes of care . Med Care 1977;;15:482-487.
15 +
Dixon RH, Laszlo J:  Utilization of clinical chemistry services by medical house staff . Arch Intern Med 1974;;134:1064-1067.
16 +
Durbridge TC, Edwards F, Edwards RG, et al:  Evaluation of benefits of screening tests done immediately on admission to hospital . Clin Chem 1976;;22:968-971.
17 +
Fineberg HV:  Clinical chemistries: The high cost of low-cost diagnostic tests , in Altman SH, Blendon R (eds): Proceedings of the 1977 Sun Valley Forum on National Health , publication (PHS) 79-3216. US Dept of Health, Education, and Welfare, (August) 1977;.
18 +
Moloney TW, Rogers DE:  Medical technology: A different view of the contentious debate over costs . N Engl J Med 1979;;301:1413-1419.
19 +
Barnett RN:  Medical significance of laboratory results . Am J Clin Pathol 1968;;50:671-676.
20 +
Bennett C, Franklin N: Statistical Analysis in Chemistry and the Chemical Industry . New York, John Wiley & Sons Inc, 1954;, section 9.3.
21 +
Bowie EJW, Owen CA Jr:  The significance of abnormal preoperative hemostatic tests . Prog Hemost Thromb 1980;;5:179-209.
22 +
Huebsch LB, Harker LA:  Disorders of platelet function: Mechanism, diagnosis and management . West J Med 1981;;134:109-127.
23 +
Robbins JA, Mushlin AI:  Preoperative evaluation of the healthy patient . Med Clin North Am 1979;;63:1145-1156.
24 +
Roizen MF:  Routine preoperative evaluation , in Miller RD (ed): Anesthesia. New York, Churchill Livingstone Inc, 1982;, pp 3-19.
25 +
Delahunt B, Turnbull PRG:  How cost effective are routine preoperative investigations? NZ Med J 1980;;92:431-432.
26 +
Rossello PJ, Cruz AR, Mayol PM:  Routine laboratory tests for elective surgery in pediatric patients: Are they necessary? Lab Tests Surg Ped Patients 1980;;72:614-623.
27 +
Leonard JV, Clayton BE, Colley JRT:  Use of biochemical profile in children's hospital: Results of two controlled trials . Br Med J 1975;;2:662-665.
28 +
Eisenberg JM, Clarke JR, Sussman SA:  Prothrombin and partial thromboplastin times as preoperative screening tests . Arch Surg 1982;; 117:48-51.
29 +
Marengo-Rowe AJ, Lambert CJ, Leveson JE, et al:  The evaluation of hemorrhage in cardiac patients who have undergone extracorporeal circulation . Transfusion 1979;;19:426-433.
30 +
Schemel WH:  Unexpected hepatic dysfunction found by multiple laboratory screening . Anesth Analg 1976;;55:810-812.
31 +
Wataneeyawech M, Kelley KA Jr:  Hepatic diseases unsuspected before surgery . NY State J Med 1975;;75:1278-1281.
32 +
Gold BD, Wolfersberger WH:  Findings from routine urinalysis and hematocrit on ambulatory oral and maxillofacial surgery patients . J Oral Surg 1980;;38:677-678.
33 +
Swanson JO:  Presurgical coagulation testing . Minn Med 1976;;59:517-522.
34 +
Baranetsky NG, Weinstein P:  Partial thromboplastin time for screening . Ann Intern Med 1979;;91:498-499.
35 +
Crider EF:  Is routine laboratory (SMA) screening justified? Anesth Analg 1977;;56:470-472.
36 +
Williamson JW, Alexander M, Miller GE:  Continuing education and patient care research . JAMA 1967;;201:118-122.
37 +
Huntley RR, Steinhauser R, White KL, et al:  The quality of medical care: Techniques and investigation in the outpatient clinic . J Chron Dis 1961;;14:630-642.
38 +
Parkerson GR Jr:  Cost analysis of laboratory tests in ambulatory primary care . J Fam Pract 1978;;7:1001-1007.
39 +
Parkerson GR Jr:  Determinants of physician recognition and follow-up of abnormal laboratory values . J Fam Pract 1978;;7:341-349.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Ashley JSA, Parker P, Beresford TC:  How much clinical investigation? Lancet 1972;;1:890-892.
2 +
Carmalt MHB, Whitehead TP:  Biochemical profiles and length of hospital stay . Proc R Soc Med 1971;;64:257-259.
3 +
Korvin CC, Pearce RH, Stanley J:  Admissions screening: Clinical benefits . Ann Intern Med 1975;;83:197-203.
4 +
Martin SP, Donaldson MC, London CD, et al:  Inputs into coronary care during 30 years: A cost effectiveness study . Ann Intern Med 1974;; 81:289-293.
5 +
Griner PF:  Treatment of acute pulmonary edema: Conventional or intensive care? Ann Intern Med 1972;;77:501-506.
6 +
Myers LP, Schroeder SA:  Physician use of services for the hospitalized patient: A review, with implications for cost containment . Milbank Mem Fund Q 1981;;59:481-487.
7 +
Griner PF, Liptzin B:  Use of the laboratory in a teaching hospital: Implications for patient care, education, and hospital costs . Ann Intern Med 1971;;75:157-163.
8 +
Bold AM, Corrin B:  Use and abuse of clinical chemistry in surgery . Br Med J 1965;; 2:1051-1052.
9 +
Eisenberg M, Williams SV, Garner L, et al:  Computer-based audit to detect and correct overutilization of laboratory tests . Med Care 1977;;15:915-921.
10 +
Druckman E (ed):  Do doctors order too many tests? CAHP Newsletter 1979;;3:1.
11 +
Jacobson KW, Branch LB, Nelson HS:  Laboratory tests in chronic urticaria . JAMA 1980;;243:1644-1646.
12 +
Abrams HL:  The overutilization of x-rays . N Engl J Med 1979;;300:1213-1216.
13 +
Schroeder SA, Schliftman A, Piemme TE:  Variation among physicians in use of laboratory tests: Relation to quality of care . Med Care 1974;;12:709-713.
14 +
Daniels M, Schroeder SA:  Variation among physicians in use of laboratory tests: II. Relation to clinical productivity and outcomes of care . Med Care 1977;;15:482-487.
15 +
Dixon RH, Laszlo J:  Utilization of clinical chemistry services by medical house staff . Arch Intern Med 1974;;134:1064-1067.
16 +
Durbridge TC, Edwards F, Edwards RG, et al:  Evaluation of benefits of screening tests done immediately on admission to hospital . Clin Chem 1976;;22:968-971.
17 +
Fineberg HV:  Clinical chemistries: The high cost of low-cost diagnostic tests , in Altman SH, Blendon R (eds): Proceedings of the 1977 Sun Valley Forum on National Health , publication (PHS) 79-3216. US Dept of Health, Education, and Welfare, (August) 1977;.
18 +
Moloney TW, Rogers DE:  Medical technology: A different view of the contentious debate over costs . N Engl J Med 1979;;301:1413-1419.
19 +
Barnett RN:  Medical significance of laboratory results . Am J Clin Pathol 1968;;50:671-676.
20 +
Bennett C, Franklin N: Statistical Analysis in Chemistry and the Chemical Industry . New York, John Wiley & Sons Inc, 1954;, section 9.3.
21 +
Bowie EJW, Owen CA Jr:  The significance of abnormal preoperative hemostatic tests . Prog Hemost Thromb 1980;;5:179-209.
22 +
Huebsch LB, Harker LA:  Disorders of platelet function: Mechanism, diagnosis and management . West J Med 1981;;134:109-127.
23 +
Robbins JA, Mushlin AI:  Preoperative evaluation of the healthy patient . Med Clin North Am 1979;;63:1145-1156.
24 +
Roizen MF:  Routine preoperative evaluation , in Miller RD (ed): Anesthesia. New York, Churchill Livingstone Inc, 1982;, pp 3-19.
25 +
Delahunt B, Turnbull PRG:  How cost effective are routine preoperative investigations? NZ Med J 1980;;92:431-432.
26 +
Rossello PJ, Cruz AR, Mayol PM:  Routine laboratory tests for elective surgery in pediatric patients: Are they necessary? Lab Tests Surg Ped Patients 1980;;72:614-623.
27 +
Leonard JV, Clayton BE, Colley JRT:  Use of biochemical profile in children's hospital: Results of two controlled trials . Br Med J 1975;;2:662-665.
28 +
Eisenberg JM, Clarke JR, Sussman SA:  Prothrombin and partial thromboplastin times as preoperative screening tests . Arch Surg 1982;; 117:48-51.
29 +
Marengo-Rowe AJ, Lambert CJ, Leveson JE, et al:  The evaluation of hemorrhage in cardiac patients who have undergone extracorporeal circulation . Transfusion 1979;;19:426-433.
30 +
Schemel WH:  Unexpected hepatic dysfunction found by multiple laboratory screening . Anesth Analg 1976;;55:810-812.
31 +
Wataneeyawech M, Kelley KA Jr:  Hepatic diseases unsuspected before surgery . NY State J Med 1975;;75:1278-1281.
32 +
Gold BD, Wolfersberger WH:  Findings from routine urinalysis and hematocrit on ambulatory oral and maxillofacial surgery patients . J Oral Surg 1980;;38:677-678.
33 +
Swanson JO:  Presurgical coagulation testing . Minn Med 1976;;59:517-522.
34 +
Baranetsky NG, Weinstein P:  Partial thromboplastin time for screening . Ann Intern Med 1979;;91:498-499.
35 +
Crider EF:  Is routine laboratory (SMA) screening justified? Anesth Analg 1977;;56:470-472.
36 +
Williamson JW, Alexander M, Miller GE:  Continuing education and patient care research . JAMA 1967;;201:118-122.
37 +
Huntley RR, Steinhauser R, White KL, et al:  The quality of medical care: Techniques and investigation in the outpatient clinic . J Chron Dis 1961;;14:630-642.
38 +
Parkerson GR Jr:  Cost analysis of laboratory tests in ambulatory primary care . J Fam Pract 1978;;7:1001-1007.
39 +
Parkerson GR Jr:  Determinants of physician recognition and follow-up of abnormal laboratory values . J Fam Pract 1978;;7:341-349.

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