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Clinical Utility of Routine Preoperative Laboratory Assessment in a Urogynecologic Population

Geynisman-Tan, Julia MD; Bochenska, Katarzyna MD; Gillingham, Akira MD; Collins, Sarah MD; Lewicky-Gaupp, Christina MD; Mueller, Margaret MD; Kenton, Kimberly MD, MS

Female Pelvic Medicine & Reconstructive Surgery: July 3, 2018 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/SPV.0000000000000606
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Objective The objective of this study was to determine the incidence of newly diagnosed, clinically meaningful laboratory abnormalities on routine preoperative laboratory testing in women undergoing urogynecologic surgery.

Methods All urogynecologic cases performed at a single institution over a 3-year period were reviewed. Women undergoing major surgery routinely had a basic metabolic panel, complete blood count (CBC), and type and screen, whereas women undergoing minor surgery had testing at the surgeon's discretion. Demographics, surgical details, preoperative laboratory values, and instances of postoperative transfusion were abstracted. If testing revealed a clinically meaningful abnormality, physician notes were reviewed to determine whether the abnormality was previously known or led to surgical postponement.

Results A total of 836 cases were identified: 411 major (49%) and 425 minor (51%). Patients had a mean ± SD age of 57 ± 13 years and body mass index of 27 ± 6 kg/m2. Medical comorbidities were hypertension, 38%; diabetes, 24%; chronic kidney disease, 3%; and congestive heart failure, 4%; 89% had an American Society of Anesthesiologists class of less than or equal to 2. A total of 453 (54%) had preoperative CBC, and 367 (44%) had preoperative basic metabolic panel. Six (1.3%) new abnormalities (hemoglobin between 8.0 and 10.0) were identified on CBC. Thirty-one women had elevated creatinine level (>1.0), and 28 (90%) of these had a history of hypertension. No surgeries were postponed or changed owing to anemia, thrombocytopenia, or renal dysfunction. No clinically significant electrolyte abnormalities were identified. Type and screen were collected on 394 patients; none were transfused intraoperatively.

Conclusions Routine preoperative laboratory testing does not identify clinically meaningful abnormalities or alter surgical management in women undergoing urogynecologic surgery.

From the Division of Female Pelvic Medicine and Reconstructive Surgery, Northwestern University, Chicago, IL.

Correspondence: Julia Geynisman-Tan, MD, Division of Female Pelvic Medicine and Reconstructive Surgery, Northwestern University, 250 E Superior St, Suite 05-2370, Chicago, IL. E-mail: Julia.Geynisman-Tan@nm.org.

K.K. has grant funding from Boston Scientific. K.K. and S.C. are expert witness for Ethicon. The remaining authors have no conflicts of interest to report.

The authors have declared they have no conflicts of interest.

International review board approved on August 29, 2017 by Northwestern University (international review board approval number: STU00205935).

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