Usefulness and cost-efectiveness of preoperative test in otolaryngological surgery

Abstract

Introduction: Although most surgeons order pre-operative laboratory tests, this practice is not based upon any evidence. Furthermore, they impose a potentially important monetary cost on the patient. Aim: To determine the usefulness and cost-effectiveness of preoperative tests in otolaryngology. Material and method: Retrospective study. A sample of 160 medical records of ASA I patients (2 to 40 years of age, without other known pathologies) that underwent surgery at the San Juan de Dios Hospital during 2006 was reviewed. Results: None of the tests ordered predicted any of the perisurgical complications found. Among patients with normal results, 4 had complications. It took 70 tests (at a cost of $ 703,500 Chilean pesos or U$D 1256) to detect a relevant pathology. Detection of abnormalities in test results forced significant more clinical interventions, and was associated with an increased number of medical consults (4.4 vs 2.53 p = 0.0002) and a prolonged hospital stay (2.5 vs 1.77 p = 0025). 20.1% of the test were repeated tests, mainly because they had passed the valid date(45.1%). The opportunity-cost associated with pre- operative examinations averaged $ 28,608 per patient, which (as a reference) is equivalent annually to 27% of the cost of all tonsillectomies performed at this center each year. Conclusion: Routine pre-operative testing seems to be an expensive and useless practice.