Department of Surgery, Division of Plastic Surgery, Hospital of the University of Pennsylvania, Philadelphia.
Aesthet Surg J. 2014 Jan 1;34(1):133-41. doi: 10.1177/1090820X13515880. Epub 2013 Dec 12.
Preoperative laboratory testing is commonplace in the clinical setting and is often utilized at surgeon discretion. We searched the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) data set to determine the impact of preoperative laboratory testing in ambulatory plastic surgery patients.
The authors assess the utilization and predictive value of preoperative laboratory testing in outpatient plastic surgery procedures.
Patients undergoing ambulatory plastic surgery were identified from the 2005 to 2010 NSQIP databases. Laboratory tests were categorized by group: hematologic, chemistry, coagulation, and liver function tests (LFT). We defined complications in 2 groups: major postoperative and wound complications. Multivariate analyses were used to identify patient characteristics associated with testing and to assess the ability of laboratory testing to predict postoperative complications.
A total of 5359 (62.0%) patients underwent testing; 881 (16.4%) tests were performed on the day of surgery. In patients with no defined NSQIP comorbidities, 59.4% underwent preoperative testing and had a significantly lower rate of abnormal findings (33.4% vs 25.3%, P < .0001). In multivariate analyses, testing was associated with older age, American Society of Anesthesiologists class >2, Hispanic or African American race, body contouring procedures, epidural or spinal procedures, and with diabetes, hypertension, and cancer. Major complications occurred in 0.34% of patients. Our analysis demonstrated that neither testing nor abnormal results were associated with postoperative complications, either major (P = .178) or wound (P = .150).
We found no association between abnormal laboratory testing and postoperative morbidity. Preoperative testing in low-risk ambulatory plastic surgery patients may be costly and has limited direct clinical benefit.
术前实验室检查在临床实践中很常见，通常由外科医生自行决定是否进行。我们在美国外科医师学院-国家外科质量改进计划（ACS-NSQIP）数据库中搜索，以确定术前实验室检查对门诊整形手术患者的影响。
作者评估门诊整形手术患者术前实验室检查的使用情况及其预测价值。
从 2005 年至 2010 年的 NSQIP 数据库中确定接受门诊整形手术的患者。将实验室检查分为血液学、化学、凝血和肝功能检查（LFT）。我们将并发症定义为两组：主要术后并发症和伤口并发症。采用多变量分析确定与检查相关的患者特征，并评估实验室检查预测术后并发症的能力。
共有 5359 名（62.0%）患者接受了检查；881 项（16.4%）检查在手术当天进行。在无明确 NSQIP 合并症的患者中，59.4%接受了术前检查，异常发现率显著降低（33.4%比 25.3%，P<0.0001）。在多变量分析中，检查与年龄较大、美国麻醉师协会分级>2、西班牙裔或非裔美国人种族、体型塑造手术、硬膜外或脊髓手术以及糖尿病、高血压和癌症有关。主要并发症发生率为 0.34%。我们的分析表明，检查或异常结果与术后并发症（主要并发症：P=0.178；伤口并发症：P=0.150）均无相关性。
我们发现异常实验室检查与术后发病率之间无关联。低风险门诊整形手术患者的术前检查可能费用昂贵，且直接临床获益有限。
