Routine Preoperative Evaluation in Surgical Patient

Study Overview
=================
Brief Summary
-----------------
The routine pre-operative tests in healthy orthopaedic patients undergoing intermediate/ major surgery are not justified. In this study of 670 healthy orthopedic patients with 7610 preoperative tests, investigators found that surgical plan was influenced in <1% of patients. Surgeons should be sensitized to reconsider this practice particularly with limited resources.

Detailed Description
-----------------
Background: Routine preoperative tests in healthy patients not only cause extra anxiety, but may delay treatment without influencing surgical plan. This has worse impact in resource-constrained settings where fee for service rather than health insurance is the usual norm. Investigators aim to determine if routine pre-operative tests are justified in healthy orthopedic patients. Methods: Investigators conducted a non-commercialized, non-funded matched case control study in tertiary care university hospital and a level-1 trauma centre for healthy patients (ASA-1&2) admitted from January 2014-December 2016 for elective orthopedic intermediate and major procedures. Cases (patient who had a change in his/her surgical plan after admission) and controls were selected independently of the exposure of interest then matched randomly to cases on age, gender and procedure type. Primary exposure was the routine preoperative lab tests, as defined by the American Society of Anesthesiologist, which included 13 blood tests. Analysis was done using Principle Component Analysis and Conditional logistic regression at univariate and multivariable levels reporting matched adjusted Odds Ratios. The data will bereported in line with STROBE criteria. .

Official Title
-----------------
Does More Testing in Routine Preoperative Evaluation Benefit the Surgical Patient? Matched Case Control Study From a Resource-constrained Setting

Conditions
-----------------
Orthopedic Disorder

Intervention / Treatment
-----------------
* Other: preoperative blood tests


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Participants irrespective of age and gender. ASA-1 and ASA-2 status. Primary elective orthopedic procedures. Blood lab tests done at the institution only. Exclusion Criteria: Ambulatory care procedures Revision surgery. Participants admitted to other services, high care or intensive care units.

Ages Eligible for Study
-----------------
Minimum Age: 1 Year
Maximum Age: 100 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
Accepts Healthy Volunteers

Study Plan
=================
How is the study designed?
-----------------

Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Cases<br>nested from on going retrospective cohort study. Participants who had change in their surgical plan after hospitalization. | Other: preoperative blood tests<br> <br> |
| Controls<br>nested from on going retrospective cohort study. Participants who didn't have change in their surgical plan after hospitalization. | Other: preoperative blood tests<br> <br> |

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| preoperative blood tests compliance rate with institutional guidelines | compliance rate (%) with institutional and international guidelines measured by a questionnaire including whether participant was advised preoperative lab tests in compliance with the institutional guidelines or not. | 2014-2019 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Cost difference in local currency | of compliant group Vs non compliant | 2014-2019 | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
preoperative evaluation, orthopedic surgery