Reazaul Karim Habib Md, Prakash Avinash, Sahoo Sarasa Kumar, Narayan Anilkumar, Vijayan Vidya
Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India.
Department of Anaesthesiology, Andaman and Nicobar Islands Institute of Medical Sciences and GB Pant Hospital, Port Blair, Andaman and Nicobar Islands, India.
Indian J Anaesth. 2018 Jan;62(1):23-28. doi: 10.4103/ija.IJA_223_17.
One of the reasons for continued routine pre-operative testing practice is the identification of hidden problems which may affect perioperative management. This study was aimed to assess the prevalence of abnormal test results, their impact on perioperative management and cost-effectiveness for detecting such abnormalities.
This observational study was conducted by screening the files of the patients attending pre-anaesthetic check-up during December 2016-January 2017. Patients' physical status, surgery grade, normal and abnormal test results and different impacts were noted and expressed in absolute numbers/percentage. Number needed to investigate (NNI) to detect a significant abnormality was calculated.
Data of 414 patients (46.3% male) with mean ± standard deviation age 43.78 ± 17.24 years and 58.65 ± 12.93 kg weight were analysed. Patients were mostly American Society of Anesthesiologists II and underwent National Institute of Clinical and Health Excellence Grade 3 surgeries. Totally, 345 (11.6%) test results were abnormal. Only 56 (16.2%) abnormalities had an impact in terms of referral, further investigations or delay. Twenty were significant in terms of changing perioperative anaesthetic management. Laboratory abnormalities with non-significant impact resulted in median delay of 3 days (range 1 to 12 days). The NNI for a significant impact and detecting new abnormality was 21 and 28, respectively.
Majority (57.2%) of the patients had at least one abnormal routine test result but only 1.8% abnormalities had significant impact. The NNI to find a significant impact or hidden comorbidity was more than 20.
持续进行常规术前检查的原因之一是识别可能影响围手术期管理的潜在问题。本研究旨在评估异常检查结果的发生率、其对围手术期管理的影响以及检测此类异常的成本效益。
本观察性研究通过筛查2016年12月至2017年1月期间接受麻醉前检查的患者档案进行。记录患者的身体状况、手术分级、正常和异常检查结果以及不同影响，并以绝对数/百分比表示。计算检测到显著异常所需调查的数量（NNI）。
分析了414例患者的数据（男性占46.3%），平均年龄±标准差为43.78±17.24岁，体重为58.65±12.93kg。患者大多为美国麻醉医师协会II级，接受国家临床和健康卓越研究所3级手术。共有345项（11.6%）检查结果异常。只有56项（16.2%）异常在转诊、进一步检查或延迟方面有影响。20项在改变围手术期麻醉管理方面具有显著性。影响不显著的实验室异常导致中位延迟3天（范围1至12天）。产生显著影响和检测到新异常的NNI分别为21和28。
大多数（57.2%）患者至少有一项常规检查结果异常，但只有1.8%的异常有显著影响。发现显著影响或隐匿性合并症的NNI超过20。
