Routine preoperative laboratory testing in elective pediatric cardiothoracic surgery is largely unnecessary

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 153; no. 3; pp. 678 - 685
• Main Authors: Nieto, R. Michael, MD, De León, Luis E., MD, Diaz, Daniel Trujillo, MD, Krauklis, Kimberly A., CRNP, Fraser, Charles D., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2017
• Subjects: Cardiac Surgical Procedures - methods; Cardiothoracic Surgery; Child; Diagnostic Tests, Routine - statistics & numerical data; Elective Surgical Procedures; Follow-Up Studies; Heart Diseases - diagnosis; Heart Diseases - surgery; Humans; Preoperative Care - methods; preoperative laboratory correspondence; preoperative screening; Retrospective Studies; routine blood testing; routine coagulation screen; Unnecessary Procedures - statistics & numerical data; preoperative laboratory correspondence; PT; CBC; routine preoperative laboratory testing; ECG; prothrombin time; Chem7; UTI; UA; 7 chemistry metabolic panel; preoperative screening; complete blood count; PTT; routine coagulation screen; electrocardiogram; urinalysis; routine blood testing; partial thromboplastin time; RLT; CXR; chest radiograph; urinary tract infection
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/j.jtcvs.2016.10.082

Abstract Objective Routine preoperative laboratory testing (RLT) is common practice in pediatric cardiothoracic surgery and is associated with significant cost burden to patients and families. We sought to examine the value of RLT in patients undergoing elective pediatric cardiothoracic surgery. Methods We conducted a retrospective study of all scheduled elective pediatric cardiothoracic surgery at our institution from 2012 to 2014. Inpatients were excluded. Patient charts were reviewed to obtain preoperative laboratory values and determine relationship to case cancellation. RLT includes complete blood count, prothrombin time, partial thromboplastin time, urinalysis, 7 chemistry metabolic panel, electrocardiogram, and 2-view chest radiograph. Results RLT was completed for 1106 scheduled elective cases. Six (0.5%) cancellations were related to abnormal preoperative laboratory test results: 5 complete blood counts and 1 urinalysis. Hospital charge for RLT averaged $2064 per patient. Based on this incidence, we estimated that 184 routine preoperative laboratory tests, which generated a total hospital charge of $379,776, were required to capture 1 abnormal test significant enough to cancel surgery. An estimated charge of $2,169,552 was generated on prothrombin time, partial thromboplastin time, 7 chemistry metabolic panel, electrocardiogram, and 2-view chest radiograph, and none of these tests resulted in a cancellation. Conclusions RLT does not significantly impact decision-making in elective pediatric cardiothoracic surgery. The decision to order a specific screening test should be clinically driven. Selective preoperative laboratory testing may have a positive impact on healthcare costs without affecting outcomes.