Preoperative blood tests in elective general surgery: cost and clinical implications
Chelsea & Westminster Hospital, 369 Fulham Road, London SW10 9NH.Journal of perioperative practice 09/2012; 22(9):282-8.
A retrospective observational study was performed in our trust in October 2010 that examined compliance, and the financial and clinical implications of performing inappropriate preoperative blood tests on adult patients prior to elective surgery, against the 2003 NICE guidelines. An unacceptable proportion of inappropriate tests (31.3%) were being performed. None were associated with adverse outcome or changes in management. Based on our results, we estimate that an extrapolated cost of pound 11.2 million is being spent on inappropriate blood tests in NHS England and Wales.
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ABSTRACT: In the Indian context, there is a convention of doing pre-operative screening for HIV, hepatitis B virus and hepatitis C viruses for all patients as a routine pre-intervention investigation. This approach is justified in some instances in the best interest of the patient. However, as routine screening is not the standard care internationally and as there is a significant divergence of views about the merits and demerits of this practice, this issue needs to be debated in a rational manner with an evidence-based approach. The present article is authored by a surgeon and a microbiologist from a new cancer care centre in eastern India, who has attempted to address this contentious issue. The various available options have been explored, and advantages and disadvantages of the different approach have been discussed. An algorithm for infection prevention and control has been presented so that surgeons and medical microbiologists could manage infection control challenges satisfactorily.
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