Routine Preop Testing Does Not Affect Urethroplasty Outcomes

By Will Boggs MD

March 20, 2020

NEW YORK (Reuters Health) - Routine preoperative testing before urethroplasty is not associated with outcomes, according to a database study.

"Overall, we feel that many times obtaining routine preoperative labs is a knee-jerk response prior to open surgeries," Dr. Kirtishri Mishra of Case Western Reserve University School of Medicine, in Cleveland, Ohio, told Reuters Health by email. "The purpose of this paper is to highlight the practice of judicious utilization of labs, which is a simple cost-cutting measure that can have major implications on appropriation of resources that may make a significant impact in patient care."

Increasing evidence suggests that routine preoperative testing for outpatient urologic procedures may not be indicated due to the low incidence of clinically significant lab abnormalities in these patients. Urethroplasty might be one of those procedures, Dr. Mishra and colleagues suggest in Urology.

They used data from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database from 2010 through 2017 to investigate the intensity of routine preoperative testing in patients undergoing urethroplasty and the correlation between abnormal lab findings and postoperative complications.

Among the 1,527 patients who underwent a urethroplasty, three-quarters had at least one preoperative exam. Of the 8,455 individual laboratory test values (an average of seven test results per patient), only 11.3% were abnormal, but 54.4% of patients had at least one abnormal lab result.

Postoperative complications followed urethroplasty in 7.2% of patients, most commonly including urinary tract infection (3.9%), readmission (3.4%) or superficial surgical-site infection (1%).

The prevalence of complications did not differ significantly between patients who had preoperative testing and those who did not, or between patients with normal and abnormal lab results, respectively.

In multivariable analyses, the only lab value that was predictive of increased complications was an abnormal coagulation profile among patients with American Society of Anesthesiologists (ASA) classification of 3 (severe systemic disease) or worse.

"Ultimately our findings are to be utilized in conjunction with the individualized patient clinical features and their comorbidities," Dr. Mishra said. "Using the ASA classification allows practitioners to formulate their clinical decisions with a widely utilized preoperative parameter that is routinely assessed during pre-op testing."

"In this increasingly cost-conscious healthcare landscape, it is imperative that our practice is rooted in evidence," he said. "While the study acknowledges the inherent weaknesses of a retrospective, large database study, we hope that providers will be more cost-conscious of their practice patterns."

SOURCE: Urology, online February 26, 2020.