Abstract
Objective:
To determine if implementation of a standardized evidence-based preoperative testing protocol within a patient population undergoing benign gynecological surgery would reduce unindicated evaluation without an associated increase in surgical complications.
Methods:
This was a retrospective cohort study. Patients assigned female at birth who underwent scheduled benign gynecological and urogynecological surgeries from May to October 2020 (before implementation) and August to November 2021 (after implementation) were included. Demographic information, preoperative testing, perioperative outcomes, and postoperative complications were collected for all patients. Tests were compared with the standardized testing protocol to determine what was indicated or not for each individual patient. A linear regression was used to estimate differences in total number of tests performed between groups. Surgical outcomes were compared for patients who underwent surgery before and after protocol implementation.
Results:
The total cohort was 378 patients, with 197 before implementation and 181 after implementation. The American Society of Anesthesiologists class was similar between groups. Prior to implementation, providers were more likely to obtain a preoperative complete blood count (CBC) (OR = 2.87, 95% CI: 1.69–4.88), a metabolic panel (basic metabolic panel [BMP] or complete metabolic panel [CMP]) (OR = 3.55, 95% CI: 2.24–5.64), and type and screen (OR = 2.21, 95% CI: 1.38–3.55) and less likely to obtain an electrocardiogram (OR = 0.45, 95% CI: 0.20–0.99). The number of unindicated CBCs and BMP/CMPs obtained decreased significantly over the study period (p < 0.01) as did the number of unindicated type and screens (p = 0.01). Intraoperative and postoperative complications were rare and did not differ significantly between groups.
Conclusion:
Implementation of an evidence-based preoperative testing protocol resulted in a reduction in unindicated testing without an associated increase in complications.
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