Anzeige
Erschienen in:
01.06.2017 | Reports of Original Investigations
Predictors of intraoperative testing in adults undergoing noncardiac surgery within a regional hospital system
Erschienen in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Ausgabe 6/2017
Einloggen, um Zugang zu erhaltenAbstract
Background
The use of intraoperative testing is central to anesthesia practice, and point-of-care testing (POCT) is often used. Nevertheless, POCT is costly and its contribution to patient outcome is unknown. There is a lack of guidelines to describe which patients should undergo intraoperative testing or how results should be applied. As such, we undertook a historical cohort study evaluating intraoperative testing practices within our region where POCT is not used.
Methods
In 2012, we obtained a random sample of 1,000 adult patients undergoing noncardiac surgery in three of our health system hospitals. Patient, surgical, and testing details were extracted, and the surgical procedures were categorized using the Johns Hopkins risk guidelines. Our primary outcome was the administration of at least one intraoperative test. We used a multivariable logistic regression model to identify factors associated with testing and described the time from ordering the tests to receiving the results using descriptive statistics.
Results
Study results showed that 110/1,000 (11.0%) patients underwent 413 diagnostic tests. Complete blood count was the most commonly administered test (36.3%), and the mean (standard deviation) time to obtain all test results was 29.9 (19.9) min. High-risk procedures were associated with an odds ratio (OR) of 12.3 (95% confidence interval [CI], 8.3 to 18.2; P < 0.001). Other predictors of intraoperative testing included emergency surgery (OR, 3.8; 95% CI, 2.0 to 7.2; P < 0.001), number of comorbidities (OR, 1.1; 95% CI, 1.0 to 1.2; P = 0.03), and duration of surgery (OR, 2.3; 95% CI, 1.8 to 2.9; P < 0.001).
Conclusion
Intraoperative testing is common and more likely in patients undergoing high-risk surgical procedures. In a central laboratory system, there is substantial time from ordering the tests to receiving the results. The clinical impact of this delay is unknown. Further evaluation is required regarding the relationship between the time required for intraoperative test results and perioperative outcomes.