Indicação de exames pré-operatórios segundo critérios clínicos: necessidade de supervisão

Aline Pallaoro Garcia; Karen Adriana Pastorio; Rodrigo Lopes Nunes; Giovani Figueiredo Locks; Maria Cristina Simões de Almeida

doi:10.1016/j.bjan.2013.03.013

Scientific Article

Indicação de exames pré-operatórios segundo critérios clínicos: necessidade de supervisão

Indication of preoperative tests according to clinical criteria: need for supervision

Aline Pallaoro Garcia; Karen Adriana Pastorio; Rodrigo Lopes Nunes; Giovani Figueiredo Locks; Maria Cristina Simões de Almeida

http://dx.doi.org/10.1016/j.bjan.2013.03.013 Braz J Anesthesiol, vol.64, n1, p.54-61, 2014

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Resumo

Justificativa e objetivos: a solicitação indiscriminada de exames complementares na avaliação pré-anestésica é comum na prática clínica e implica custos adicionais e a possibilidade de resultados falso-positivos. Os objetivos desta pesquisa foram analisar se os exames pré-operatórios em cirurgias eletivas são solicitados segundo critério clínico e avaliar os custos desnecessários para a instituição. Métodos: foram avaliadas as solicitações de exames pré-operatórios em pacientes adultos submetidos a cirurgias eletivas não cardíacas. Os exames foram solicitados pelos cirurgiões, conforme protocolo do Serviço de Anestesia. Foram avaliados dados demográficos, estado físico, comorbidades e tipo de exame complementar solicitado. Os exames feitos foram comparados com os exames indicados. O custo dos exames foi baseado na tabela Datasus. Resultados: foram avaliados 1.063 pacientes. Verificou-se que 41,9% dos exames feitos nos pacientes classificados como ASA I não estavam indicados. No grupo de risco ASA II foram feitos 442 exames (17,72%) sem necessidade. Perceberam-se elevadas porcentagens na solicitação de hemograma, creatinina, coagulograma, raios X de tórax e ECG nos grupos ASA I-II. Apenas 40 (5,25%) dos exames feitos no grupo ASA III não estavam indicados. Nos pacientes do grupo ASA IV, 22,5% dos exames necessários não foram feitos. Ressalta-se uma economia anual de 13% (R$1.923,13) caso os exames fossem feitos conforme o protocolo. Conclusões: os exames pré-operatórios nem sempre são solicitados de acordo com critérios clínicos, o que resulta em maiores custos para a instituição.

Palavras-chave

Exames médicos, Avaliação em saúde, Custos hospitalares

Abstract

Background and objectives: The indiscriminate order for additional tests on pre-anesthetic evaluation is common in clinical practice, which entails additional costs and the possibility of false-positive results. The aim of this study was to analyze whether preoperative tests in elective surgeries are ordered according to clinical criteria and assess the unnecessary costs for the institution. Methods: Evaluation of preoperative investigations in adult patients undergoing elective non-cardiac surgery. Tests were ordered by surgeons according to the Anesthesia Service protocol. Demographic data, physical status, comorbidities, and type of ordered supplementary examination were evaluated. The tests performed were compared with the indicated tests. The cost of screening was based on Datasus' table. Results: 1063 patients were evaluated. It was found that 41.9% of the tests performed on patients classified as ASA-I were not indicated. In ASA II group, 442 tests (17.72%) were made unnecessarily. The ordered percentages of blood count, creatinine, coagulation profile, chest X-ray, and ECG were high in groups ASA I-II. Only 40 (5.25%) of the examinations made in ASA III group were not indicated. In ASA IV group, 22.5% of the required tests were not performed. We highlight an annual saving of 13% (R$ 1923.13) if tests were done according to the protocol. Conclusions: Preoperative tests are not always ordered according to clinical criteria, which results in higher costs for the institution.

Keywords

Medicalexaminations, Assessment in healthcare, Hospital costs

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Indicação de exames pré-operatórios segundo critérios clínicos: necessidade de supervisão

Indication of preoperative tests according to clinical criteria: need for supervision

Aline Pallaoro Garcia; Karen Adriana Pastorio; Rodrigo Lopes Nunes; Giovani Figueiredo Locks; Maria Cristina Simões de Almeida

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