Kling Sarah M, Taylor George A, Philp Matthew M, Poggio Juan Lucas, Ross Howard M, Kuo Lindsay E
Department of General Surgery, Temple University Lewis Katz School of Medicine, Philadelphia, Pennsylvania.
Department of General Surgery, Temple University Lewis Katz School of Medicine, Philadelphia, Pennsylvania.
J Surg Res. 2022 Feb;270:421-429. doi: 10.1016/j.jss.2021.08.042. Epub 2021 Nov 15.
Many low-risk patients receive preoperative laboratory testing (PLT) prior to elective outpatient surgery, with no effect on postoperative outcomes. This has not been studied in patients undergoing anorectal surgery. The aim of this study was to determine if PLT in this population was predictive of perioperative complications.
The 2015-2018 National Surgical Quality Improvement Program (NSQIP) databases were queried for elective ambulatory anorectal surgeries. PLT was defined as chemistry, hematology, coagulation, or liver function studies obtained ≤30 days preoperatively. American Society of Anesthesiologists (ASA) class 1 and 2 patients were included who underwent elective, ambulatory, benign anorectal surgery. Patient demographics, comorbidities, and postoperative outcomes were compared between those who did and did not receive PLT. Postoperative outcomes were defined as wound-related, procedure-related, major complications, unplanned readmission, and death occurring within 30 days. Multivariate regression analysis determined patient characteristics predictive of receiving testing.
Of 3309 patients studied, 48.6% received PLT. On multivariate analysis, older age, female sex, Black race, ASA class 2, and comorbidities were predictive of receiving testing. The complication rates were similar between patients who did and did not receive testing (4.3% versus 3.5%, P = 0.22).
PLT is performed in over half of low-risk patients receiving elective anorectal surgery. There was no difference in the rate of postoperative complications between patients who received testing or not, nor with normal versus abnormal results. PLT can be used more judiciously in this population.
许多低风险患者在择期门诊手术前接受术前实验室检查（PLT），但对术后结果并无影响。尚未在接受肛肠手术的患者中对此进行研究。本研究的目的是确定该人群中的PLT是否可预测围手术期并发症。
查询2015 - 2018年国家外科质量改进计划（NSQIP）数据库，以获取择期门诊肛肠手术的相关信息。PLT定义为术前≤30天进行的化学、血液学、凝血或肝功能检查。纳入接受择期门诊良性肛肠手术的美国麻醉医师协会（ASA）1级和2级患者。比较接受和未接受PLT的患者的人口统计学、合并症及术后结果。术后结果定义为30天内发生的与伤口相关、与手术相关、重大并发症、非计划再入院和死亡。多因素回归分析确定了预测接受检查的患者特征。
在研究的3309例患者中，48.6%接受了PLT。多因素分析显示，年龄较大、女性、黑人种族、ASA 2级及合并症是接受检查的预测因素。接受检查和未接受检查的患者并发症发生率相似（4.3%对3.5%，P = 0.22）。
超过一半接受择期肛肠手术的低风险患者进行了PLT。接受检查和未接受检查的患者术后并发症发生率无差异，检查结果正常与异常的患者之间也无差异。在该人群中可更合理地使用PLT。
