Remembering the Importance of an Old Friend: History Taking in Preoperative Evaluation of Healthy Children: A Single Center Experience
Abstract
Objective: To investigate the consequences of routine laboratory tests that lead to surgical delay or high cost in patients with a normal medical history and physical examination who undergo minor surgical interventions.
Patients and Method: Files of 1,322 patients aged between 0-16 years that had undergone elective surgical intervention within six years were reviewed.
Results: Of the 1,322 patients, 1,246 (94.3%) had normal physical examination and laboratory findings. Seventy-six children who had abnormalities in laboratory findings and physical examination were referred to pediatrics. Of the 76 pediatric referees, 42 (55.3%) were reevaluated and were diagnosed with upper respiratory tract infection (n=23; 30.2%), iron deficiency anemia (n=5; 6.5%), innocent murmur (n=4; 5.3%), thalassemia minor (n=2; 2.6%), lower respiratory tract infection (n=2; 2.6%), urinary tract infection (n=1; 1.3%), mumps (n=1; 1.3%), acute gastroenteritis (n=1; 1.3%), minimal aortic and tricuspid valve insufficiency (n=1; 1.3%), minimal aortic stenosis (n=1; 1.3%), atrial septal defect (n=1; 1.3%). Surgical interventions were delayed until the recovery of the infectious diseases. In 25 of the patients, repeated tests showed normal ranges after the second test; however nine (n=9) of the patients showed increased or decreased numbers of white blood cell counts and whose medical history and physical examination revealed signs and symptoms related to infection.
Conclusion: Routine laboratory tests contribute little to preoperative evaluation of children with normal history and physical examination undergoing low grade surgery.
References
Smetana GW, Macpherson DS. The case against routine preoperative laboratory testing. Med Clin North Am 2003; 87: 7-40.
Garcia-Miguel FJ, Serrano-Aguilar PG, Lopez-Bastida J. Preoperative assessment. Lancet 2003; 362: 1749-57.
Eckman MH, Erban JK, Singh SK, Kao GS. Screening for the risk for bleeding or thrombosis. Ann Intern Med 2003; 138: W15-24.
Burk CD, Miller L, Handler SD, Cohen AR. Preoperative history and coagulation screening in children undergoing tonsillectomy. Pediatrics 1992; 89: 691-5.
Schneider PD. Preoperative assessment of liver function. Surg Clin North Am 2004; 84: 355-73.
Hartnick CJ, Ruben RJ. Preoperative coagulation studies prior to tonsillectomy. Arch Otolaryngol Head Neck Surg 2000; 126: 684-6.
National Institute for Clinical Excellence (2004). Guidance on the use of routine preoperative testing for elective surgery. NICE Clinical Guideline No. 3. London: National Institute for Clinical Excellence. Available from: www.nice.org.uk
Vural Ç. Pediatrik Hastaların Preoperatif Değerlendirmesi. Osmangazi Tıp Dergisi 2014; 36: 38-43
Tercan E. Pediatrik Anestezide Preoperatif Hazırlık ve Premedikasyon Turkiye Klinikleri J Pediatr Sci 2006; 2: 96-100.
Akıncı SB, Sarıcaoğlu F, Dal D, Aypar Ü. Preoperatif anestetik değerlendirme. Hacettepe Tıp Dergisi 2005; 36:91-7.
France FH, Lefebvre C. Cost-effectiveness of preoperative examinations. Acta Clin Belg 1997; 52: 275-86.
Mantha S, Roizen MF, Madduri J, Rajender Y, Naidu KS, Gayatri K. Usefulness of routine preoperative testing: a prospective single-observer study. J Clin Anesth 2005;17: 51-7.
Roizen MF. More preoperative assessment by physicians and less by laboratory tests. N Engl J Med 2000; 342: 204-5.
O'Connor ME, Drasner K. Preoperative laboratory testing of children undergoing elective surgery. Anesth Analg. 1990; 70: 176-80.
López-Argumedo M., Asua J. Preoperative Evaluation in Elective Surgery.
(INAHTA Synthesis Report). Vitoria-Gasteiz. Dpt. of Health Basque
Government. Basque Office for Health Technology Assessment, Osteba. 1999
van Klei WA, Grobbee DE, Rutten CL, Hennis PJ, Knape JT, Kalkman CJ, Moons KG. Role of history and physical examination in preoperative evaluation. Eur J Anaesthesiol 2003; 20: 612-8.
Meneghini L, Zadra N, Zanette G, Baiocchi M, Giusti F. The usefulness of routine preoperative laboratory tests for one-day surgery in healthy children. Paediatr Anaesth 1998; 8: 11-5.
Narr BJ, Warner ME, Schroeder DR, Warner MA. Outcomes of patients with no laboratory assessment before anesthesia and a surgical procedure. Mayo Clin Proc. 1997; 72: 505-9.
