Think Twice: De-Implementation of Laboratory Testing After Colorectal Surgery

• Published in: Diseases of the colon & rectum Vol. 67; no. 4; pp. 587 - 595
• Main Authors: Dave, Yatee A, Temple, Larissa, Juviler, Peter, Nabozny, Michael J, Cvetanovska, Marija, Wakeman, Derek, Cannon, Lisa M
• Format: Journal Article
• Language: English
• Published: United States 01.04.2024
• ISSN: 0012-3706; 1530-0358
• DOI: 10.1097/DCR.0000000000003156

Clinically unindicated laboratory testing contributes to low-value care. Most postoperative day one labs after colorectal surgery are normal. However, no published interventions have shown reducing overall postoperative laboratory testing is safe. The aim of this study was to investigate the impact of reducing postoperative laboratory testing after colorectal surgery. This is a quality improvement study. The study was conducted at an academic center with an enhanced recovery after surgery program including 5 daily labs until discharge. All adults undergoing colorectal or small bowel surgery formed intervention and non-intervention cohorts based on surgeons who chose to opt-into the study. Pre-implementation (November 2019 - October 2021) there were 545 intervention and 577 non-intervention patients. post-implementation (November 2021 - March 2023) there were 448 intervention and 437 non-intervention patients. The intervention included 3 postoperative day one labs and subsequent clinically indicated labs. Outcome measures included laboratory tests and lab-free days. Post-intervention, the intervention group had a 33% reduction in labs per hospital stay, 26% reduction in labs per day, and 49% increase in lab-free days. There was no difference in length of stay (4 v 4; p = 0.79) or readmissions (14.9% v 12.9%; p = 0.39). The non-intervention group had no significant changes in lab work or lab-free days, with no differences in length of stay (4 v 4; p = 0.49) or readmissions (11.1% v 11.0%; p = 0.96). Demographics and complication rate were not reported. An intervention targeting reflexive laboratory testing after colorectal surgery resulted in safe, significant, sustained reductions in postoperative lab work, with substantial cost savings. These findings prompted a change in the laboratory order set to an opt-out system, and lab work reduction approaches have been implemented within other surgical divisions. Continuation and spread of these efforts are instrumental for prioritization of high-value surgical care. See Video Abstract at http://links.lww.com/DCR/Bxxx.