Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2017.10.005
Brazilian Journal of Anesthesiology
Scientific Article

Validity time of normal results of preoperative tests for surgical reintervention and the impact on postoperative outcomes

Tempo de validade dos exames pré-operatórios normais para uma reintervenção cirúrgica e o impacto nos desfechos pós-operatórios

Lafayete William Ferreira Ramos; Cristiano F. Souza; Ivan Wilson Hossni Dias; Rogério G. Oliveira; Bárbara Cristina; Marcelo Calil; João Carlos Sampaio Góes

http://dx.doi.org/10.1016/j.bjane.2017.10.005 Braz J Anesthesiol, vol.68, n2, p.154-161, 2018
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Abstract

Abstract Background and objective: There are few data defining the period of time in which preoperative tests can be considered valid. The purpose of this study was to determine the likelihood of changes in the results of preoperative tests previously normal in relation to time, and the impact of these changes on postoperative outcomes. Methods: A total of 970 patients with normal preoperative tests before the first surgery and who required a new intervention were included. The preoperative tests performed for the first procedure were compared with those performed for the second procedure. The following variables were assessed regarding their potential to induce changes in test results: sex, age, surgical risk, previous chemotherapy or radiotherapy, and presence of comorbidities. In-hospital outcomes were analyzed. Results: The median time between procedures was 27 months (6–84). The probability of change in at least one of the preoperative exams was 1.7% (95% CI: 0.5–2.9), 3.6% (95% CI: 1.8–5.4), and 6.4% (95% CI: 3.9–8.9) during the 12, 24, and 36-month intervals, respectively, for patients aged <50 years and 2.1% (95% CI: 0.7–3.5), 9.2% (95% CI: 5.9–12.5), and 13.4% (95% CI: 9.3–17.5), respectively, for patients ≥50 years of age. Age (p = 0.009), surgical risk (p < 0.001), chemotherapy (p = 0.001), radiotherapy (p = 0.012), and comorbidities (p < 0.001) were associated with the likelihood of changes in test results. Test changes were not significantly associated with in-hospital adverse outcomes (p = 0.426). Conclusion: For patients undergoing a second surgical procedure, the probability of change in previously normal preoperative tests is low during the first years after the first surgical intervention, and when changes occurred, they did not adversely affect the in-hospital postoperative outcomes.

Keywords

Preoperative period, Validity, Surgery, Postoperative outcomes, Preoperative tests

Resumo

Resumo Justificativa e objetivo: Existem poucos dados que delimitam o período de tempo em que os exames pré-operatórios podem ser considerados válidos. O objetivo deste estudo foi determinar a probabilidade de mudanças nos resultados de exames pré-operatórios previamente normais em relação ao tempo e o impacto dessas alterações nos desfechos pós-operatórios. Métodos: Foram incluídos 970 pacientes com exames pré-operatórios normais antes da primeira cirurgia e que requereram uma nova intervenção. Os exames pré-operatórios feitos para o primeiro procedimento foram comparados com aqueles feitos para o segundo procedimento. As seguintes variáveis foram analisadas em relação ao seu potencial para induzir alterações nos resultados dos exames: sexo, idade, risco cirúrgico, quimioterapia ou radioterapia prévia e presença de comorbidades. Desfechos intra-hospitalares foram analisados. Resultados: A mediana temporal entre os procedimentos foi de 27 meses (6-84). A probabilidade de alteração em pelo menos um dos exames pré-operatórios foi de 1,7% (IC 95%: 0,5-2,9), 3,6% (IC 95%: 1,8-5,4) e 6,4% (IC 95%: 3,9-8,9) nos intervalos 12, 24 e 36 meses, respectivamente, para pacientes < 50 anos e 2,1% (IC 95%: 0,7-3,5), 9,2% (IC 95%: 5,9-12,5) e 13,4% (IC 95%: 9,3-17,5), respectivamente, para pacientes ≥ 50 anos. Idade (p = 0,009), risco cirúrgico (p < 0,001), quimioterapia (p = 0,001), radioterapia (p = 0,012) e presença de comorbidades (p < 0,001) estavam associadas com a probabilidade de mudanças nos resultados dos exames. Alterações nos exames não se associaram significativamente a desfechos intra-hospitalares adversos (p = 0,426). Conclusão: Para pacientes submetidos a um segundo procedimento cirúrgico, a probabilidade de alteração nos exames pré-operatórios previamente normais é baixa durante os primeiros anos após a primeira intervenção cirúrgica e quando ocorreram mudanças não afetaram adversamente os desfechos pós-operatórios intra-hospitalares.

Palavras-chave

Período pré-operatório, Validade, Cirurgia, Desfecho pós-operatório, Testes preoperatórios

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