Preoperative Metabolic Panel Prior to Minor Laparoscopic Gynecological Surgery Does Not Affect Intraoperative Outcome

Abstract

Objectives:

This study aims to determine the necessity of obtaining a basic metabolic panel (BMP) and/or comprehensive metabolic panel (CMP) prior to minor laparoscopic gynecological surgery by looking at intraoperative anesthetic or surgical complications in patients with electrolyte abnormalities found on routine testing.

Methods:

The electronic medical record (Epic Systems Corporation) was queried for patients who had received minor laparoscopic gynecological surgery at Jeanes Hospital or Temple University Hospital in Philadelphia, Pennsylvania, between January 1, 2018, and December 31, 2022. Patients included underwent laparoscopic adnexal surgeries or exploratory laparoscopy. Patients included had complete blood count (CBC), BMP, or CMP performed within 4 months of their surgery. Patients who had BMP or CMP were included as cases. Patients with only CBC were used as the control group, resulting in 117 cases and 121 controls. Charts were then analyzed for either anesthetic or intraoperative surgical complications. Anesthesia complication was defined as any complication as documented by anesthesia (i.e., arrhythmias, significant desaturations). Surgical complication was defined as documentation of complication noted by the surgeon in the operative note (i.e., uterine perforation, instrument malfunction, laparotomy). Continuous data were analyzed using the Wilcoxon test, while categorical data were analyzed using the chi-square or Fisher’s test. A p-value of <0.05 was considered statistically significant.

Results:

Among 117 cases, 47 patients (40.2%) had no electrolyte abnormalities on routine preoperative labs, and a total of 70 cases (59.8%) had some form of electrolyte abnormality preoperatively. Only one case received preoperative repletion based on labs collected in the Emergency Room, despite normal preoperative laboratories. Of the 70 cases with an abnormality, 4 had an anesthetic or surgical complication (0.05%) as compared with 1 patient out of 47 who had no electrolyte abnormalities (0.02%). There was no significant difference in anesthetic or surgical complications between cases with or without an electrolyte abnormality (p = 0.52). There was no significant difference in anesthetic or surgical complications between cases and controls (p = 0.91). No life-threatening anesthetic or surgical complications were noted within this study group.

Conclusions:

The majority of cases had some form of electrolyte abnormality; however, few had any form of preoperative intervention, and the case proceeded as planned. Additionally, there was no significant difference in the number of anesthetic or surgical complications between the two study groups. This study suggests that routine BMP or CMP prior to minor gynecological laparoscopic surgery does not change outcomes for patients and may be an unnecessary step, potentially saving the patient and hospital both time and money prior to surgery. Further research is needed to investigate the necessity of metabolic panel in a more age-diverse population prior to minor and major gynecological laparoscopic surgeries for increased applicability.