Impact of using a local protocol in preoperative testing: blind randomized clinical trial.

ABSTRACT Objective: to evaluate the impact of the use of a local protocol of preoperative test requests in reducing the number of exams requested and in the occurrence of changes in surgical anesthetic management and perioperative complications. Methods: we conducted a randomized, blinded clinical trial at the Gaffrée and Guinle University Hospital with 405 patients candidates for elective surgery randomly divided into two groups, according to the practice of requesting preoperative exams: a group with non-selectively requested exams and a protocol group with exams requested according to the study protocol. Studied exams: complete blood count, coagulogram, glycemia, electrolytes, urea and creatinine, ECG and chest X-ray. Primary outcomes: changes in surgical anesthetic management caused by abnormal exams, reduction of the number of exams requested after the use of the protocol and perioperative complications. Results: there was a significant difference (p<0.001) in the number of exams with altered results between the two groups (14.9% vs. 29.1%) and a reduction of 57.3% in the number of exams requested between the two groups (p<0.001), which was more pronounced in patients of lower age groups, ASA I, without associated diseases and submitted to smaller procedures. There was no significant difference in the frequency of conduct changes motivated by the results of exams or complications between the two groups. In the multivariate analysis, complete blood count and coagulogram were the only exams capable of modifying the anesthetic-surgical management. Conclusion: the proposed protocol was effective in eliminating a significant number of complementary exams without clinical indication, without an increase in perioperative morbidity and mortality.

摘要
目的：评估术前检查申请本地方案的使用，对减少检查申请数量、改变手术麻醉管理及围手术期并发症发生情况的影响。
方法：在加夫雷-盖因勒大学医院（Gaffrée and Guinle University Hospital）开展一项随机盲法临床试验，共纳入405名择期手术候选患者，根据术前检查申请方式随机分为两组：非选择性申请检查的对照组，以及依据本研究方案申请检查的方案组。本次研究涉及的检查项目包括：全血细胞计数、凝血功能检查、血糖检测、电解质检测、尿素及肌酐检测、心电图(ECG)以及胸部X线摄影。
主要结局指标：由异常检查结果导致的手术麻醉管理变更、使用方案后检查申请数量的减少情况，以及围手术期并发症。
结果：两组间结果异常的检查数量占比存在显著差异（p<0.001），分别为14.9%与29.1%；方案组较对照组的检查申请总数减少57.3%（p<0.001），该减少效应在低龄、美国麻醉医师协会分级I级(ASA I)、无基础合并疾病且接受小型手术操作的患者中更为显著。两组间因检查结果引发的诊疗操作变更频率及并发症发生率均无显著差异。多因素分析显示，仅全血细胞计数与凝血功能检查可改变手术麻醉管理方案。
结论：本研究所提出的术前检查申请方案可有效剔除大量无临床指征的补充检查，且未升高围手术期发病率与死亡率。