Preoperative exams: a critical analysis
Exames complementares pré-operatórios: análise crítica
Lígia Andrade da Silva Telles Mathias ; Álvaro Antonio Guaratini ; Judymara Lauzi Gozzani ; Luiz Antonio Rivetti
Abstract
BACKGROUND AND OBJECTIVES: Preoperative evaluation can benefit from laboratory exams in specific patients. The habit of requesting a set of standardized exams has been questioned. The objective of this review was to analyze recent reports on the subject and compare their results.
CONTENTS: The results obtained from a systematic revision of the evidence available from 1966 to 1996, from the recommendations of the task force of the American Society of Anesthesiologists, from the systematic revision of evidence from 1997 to 2002, and from the English National Health Service Orientation Guide.
CONCLUSIONS: Preoperative exams should not be based on standard routines, but on the patient's history, physical exam, and type and extent of surgery.
Resumo
JUSTIFICATIVA E OBJETIVOS: A avaliação pré-operatória pode se beneficiar da solicitação de exames complementares em determinados pacientes. A prática, comum há alguns anos, de conjuntos padronizados de exames solicitados rotineiramente tem sido questionada. O objetivo desta revisão foi analisar recentes publicações sobre o assunto comparando seus resultados.
CONTEÚDO: Foram analisados os resultados observados em revisão sistemática com as evidências disponíveis entre os anos de 1966 e 1996, em recomendações da força-tarefa da Sociedade Americana de Anestesiologistas, em atualização da revisão sistemática incluindo evidências de 1997 a 2002 e no Guia de Orientação do National Health Service da Inglaterra.
CONCLUSÕES: Os exames pré-operatórios não devem ser solicitados com base em rotinas, mas orientados pelo histórico clínico, exame físico e tipo e porte do procedimento cirúrgico.
References
01. Practice advisory for preanesthesia evaluation: a report by the American Society of Anesthesiologists Task Force on Preanesthesia Evaluation. Anesthesiology, 2002;96:485-496. [ Links ]
02. Pasternak LR — Preoperative evaluation, testing, and planning. Anesthesiol Clin North Am, 2004;22:XIII-XIV [ Links ]
03. Robbins JA, Mushlin AI — Preoperative evaluation of healthy patient. Med Clin North Am, 1979;63:1145-1156. [ Links ]
04. Price CP — Evidence-based laboratory medicine: supporting decision-making. Clin Chem, 2000;46:1041-1050. [ Links ]
05. Roizen MF, Cohn S — Preoperative evaluation for elective surgery what laboratory tests are needed? Adv Anesth, 1993;10:25-47. [ Links ]
06. Macpherson DS, Snow R, Lofgren RP — Preoperative screening: value of previous tests. Ann Intern Med, 1990;113:969-973. [ Links ]
07. Narr BJ, Hansen TR, Warner MA — Preoperative laboratory screening in healthy Mayo patients: cost-effective elimination of tests and unchanged outcomes. Mayo Clin Proc, 1991;66:155-159. [ Links ]
08. Foss JF, Apfelbaum J — Economics of preoperative evaluation clinics. Curr Opin Anaesthesiol, 2001;14:559-562. [ Links ]
09. Kaplan EB, Sheiner LB, Boeckmann AJ — The usefulness of preoperative laboratory screening. JAMA, 1985;253:3576-3581. [ Links ]
10. Turnbull JM, Buck C — The value of preoperative screening investigations in otherwise healthy individuals. Arch Intern Med, 1987; 147:1101-1105. [ Links ]
11. Korvin CC, Pearce RH, Stanley J — Admissions screening: clinical benefits. Ann Intern Med, 1975;83:197-203. [ Links ]
12. Macpherson DS — Preoperative laboratory testing: should any tests be "routine" before surgery? Med Clin North Am, 1993; 77:289-308. [ Links ]
13. Pollard JB, Zboray AL, Mazze RI — Economic benefits attributed to opening a preoperative evaluation clinic for outpatients. Anesth Analg, 1996;83:407-410. [ Links ]
14. Fischer SP — Cost-effective preoperative preparation. IARS Review Course Lectures. Anesth Analg, 1997;(Suppl):45-49. [ Links ]
15. Gathe-Ghermay JC, Liu LL — Preoperative programs in Anesthesiology. Anesthesiol Clin North America, 1999;17:335-353. [ Links ]
16. Kopp VJ — Preoperative preparation. Value, perspective, and practice in patient care. Anesthesiol Clin North America, 2000; 13:551-574. [ Links ]
17. Lew TW, Lai YC — Pre-operative tests — more is not necessarily better. Singapore Med J, 2003;44:333-335. [ Links ]
18. Lim EH, Liu EH — The usefulness of routine preoperative chest X-rays and ECGs: a prospective audit. Singapore Med J, 2003; 44:340-343. [ Links ]
19. Roizen MF — Cost-effective preoperative laboratory testing. JAMA, 1994;271:319-320. [ Links ]
20. Roizen MF — More preoperative assessment by physicians and less by laboratory tests. N Engl J Med, 2000;342:204-205. [ Links ]
21. Gibby GL — How preoperative assessment programs can be justified financially to hospital administrators. Int Anesthesiol Clin, 2002;40:17-30. [ Links ]
22. Fischer SP — Do preoperative clinic improve operating room efficiency? Sem Anesth Periop Med Pain, 1999;18:273-280. [ Links ]
23. François C — Public demand for grater safety: What solutions can be proposed? Curr Opin Anaesthesiol, 2002;15:225-226. [ Links ]
24. Fischer SP — Development and effectiveness of an anesthesia preoperative evaluation clinic in a teaching hospital. Anesthesiology, 1996;85:196-206. [ Links ]
25. Fu ES, Scharf JE, Glodek J — Preoperative testing: a comparison between HealthQuiz recommendations and routine ordering. Am J Anesthesiol, 1997;24:237-240. [ Links ]
26. Starsnic MA, Guarnieri DM, Norris MC — Efficacy and financial benefit of an anesthesiologist- directed university preadmission evaluation center. J Clin Anesth, 1997;9:299-305. [ Links ]
27. Fleisher LA — Effect of perioperative evaluation and consultation on cost and outcome of surgical care. Curr Opin Anaesthesiol, 2000;13:209-213. [ Links ]
28. Pollard JB — Economic aspects of an anesthesia preoperative evaluation clinic. Curr Opin Anaesthesiol, 2002;15:257-261. [ Links ]
29. van Klei WA, Moons KG, Rutten CL et aI — The effect of outpatient preoperative evaluation of hospital inpatients on cancellation of surgery and length of hospital stay. Anesth Analg, 2002;94:644-649. [ Links ]
30. Mendes FF, Mathias LAST, Duval Neto GF et al — Impacto da implantação de clínica de avaliação pré-operatória em indicadores de desempenho. Rev Bras Anestesiol, 2005;45:175-187. [ Links ]
31. Finegan BA, Rashiq S, McAlister FA et al — Selective ordering of preoperative investigations by anesthesiologists reduces the number and cost of tests. Can J Anaesth, 2005;52:575-580. [ Links ]
32. Munro J, Booth A, Nicholl J — Routine preoperative testing: a systematic review of the evídence. Health Technol Assess, 1997;1:1-62. [ Links ]
33. National Collaborating Centre for Acute Care — Preoperatíve tests — the use of routine preoperatíve tests for elective surgery. Evidence, methods & guidance, London: Nice. 2003, http//www.nice.org.uk/pdf/CG3NICEguideline.pdf 23/09/2005 [ Links ]
34. Joo HS, Wong J, Naik VN et al — The value of screening preoperative chest x-rays: a systematic review. Can J Anesth, 2005; 52:568-574.
Facebook
Google+
Twitter
LinkedIn
Mendeley
StumbleUpon
CiteULike
Reddit
Email