Preoperative Medical Evaluation in Elective Surgery versus Standard Criteria

The routine use of preoperative appropriate paraclinic testing is useful in patients scheduled to undergo elective surgery. The purpose of this study was to assess the prevalence of unnecessary preoperative evaluation performed for patients undergoing elective surgeries.
This descriptive analytic study was performed to assess the patterns of preoperative evaluation tests on 498 patients undergoing elective surgery at Shahid Beheshti and Yahyanejhad Hospitals, Babol; from January 2008 to January 2009. The patients'' data such as age, gender, preoperative medical histories, drug used, American Society of Anesthesiologists status (ASA), preoperative diagnosis, hospitals name, admission ward and type of surgery were collected. Then we compared these data to the national standards of preoperative evaluation tests presented with international guidelines as well as by the Health Ministry of Iran.
Four hundred ninety-eight patients [ 209 males (41.9%) and 289 female (58%)] with the mean age of 39.2 years were studied. Most of the patients (62%) were below 40 yea .Based on and in matching with A.S.A and Health Ministry standards for preoperative assessment, the most common unnecessary orders tested were ECG that was unnecessary in 77.3%. The frequencies of unnecessary tests for WBC, FBS, AST, ALT and chest X ray were 63.7, 40.4, 40, 33.3, and 32.8%, respectively.
The results show that the unnecessary preoperative orders evaluation tests had no indication in 32-77% of subjects.