Introduction: Routine preoperative laboratory investigation is still a common practice in some parts of the world despite numerous national/international guidelines and individual efforts discouraging this trend. The purpose of this study is to remind again that laboratory tests without indications can be safely eliminated from preoperative assessment of elective surgical patients.Settings: King Fahad Medical City, Riyadh, Saudi Arabia.Methods: All patients who underwent elective surgery at our institution in the year 2009 were reviewed retrospectively. Results of Complete Blood Count (CBC), Electrolytes and Coagulation profile were documented and characterized. Patients were divided in two groups based on indication or no indication for a specified test. Indications for tests were identified from preoperative notes taking assistance from The Canadian Anesthesiologists Society (CAS) guidelines and Harvard Medical School study as reference. Change of management due to the abnormal results was labeled as intervention. Fisher’s exact test was used to compare rate of intervention between the groups.Results: A total of 1930 patients met the inclusion criteria. In comparison to 30 (3.58%) interventions in 839 patients who were indicated for CBC before surgery, interventions were observed in only 2 (0.18%) patients among 1091 patients who actually were not requiring this test for pre-operative evaluation and the difference was highly significant (P<0.01).No intervention was identified in 1621 routinely done coagulation profiles. However, the management plan was changed in 17 (5.5%) of 309 patients having indications for coagulation profile test (P<0.01).Similarly, in electrolytes tests, of the indicated group 33 (4%) of 825 patients required intervention in comparison to 12 (1.08%) interventions of the not-indicated (1105 patients) group (P<0.01).Conclusion: Routine preoperative laboratory tests do not change patient management significantly. We hope that concerned physicians and authorities will adopt the evidence-based practice in this regard, to ensure more efficient preoperative care of patients. Introduction Laboratory investigation is a common element of preoperative evaluation of patients presenting for elective surgery. Pre-anesthesia evaluation consists of information from multiple sources that may include the patient’s medical records, interview, physical examination and findings from the medical tests and evaluations.1 In the past, a series of “routine” tests were performed to determine a patient’s fitness for surgery. Critical evaluation of “routine” tests suggested that preoperative tests ordered in the absence of clinical indications, while frequently abnormal, fail to predict postoperative outcomes. These routine tests seldom change clinical management but generate unnecessary costs for the health care system.2 Evidence-based guidelines on the use of pre-operative tests before elective surgery have been published by the National Institute for Clinical Excellence (NICE), a government organization in the UK, in 2003, where preoperative tests were not recommended routinely either in adults or in children before elective procedures in the absence of clinical indication.3 The ASA (American Society of Anesthesiologists) has published an advisory in 2002 stating similar recomendations.1 The Canadian Anesthesiologist Society (CAS) also published a guideline to assist in judicial preoperative testing.4 A prospective study showed proper history taking can safely and effectively supplement preoperative screening tests for coagulopathy.5Despite these guidelines and evidence, clinicians are still asking for the routine preoperative tests for several reasons that include detecting unsuspected abnormalities that might influence the risk of operative morbidity and mortality; establishing a baseline value for a test that has a likelihood of being monitored and changing after the surgical procedure; for medico-legal reasons; and as a tr
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