PREOPERATIVE INVESTIGATIONS IN ELECTIVE SURGERY: PRACTICES AND COSTS AT THE NATIONAL HOSPITAL OF SRI LANKA

Abstract

During preoperative preparation patients undergo investigations to detect asymptomatic diseases. The probability of finding significant abnormalities on such “routine ” investigations is small, unnecessarily increasing costs of perioperative care. We evaluated current practices, compliance with guidelines and costs of preoperative investigations at the National Hospital of Sri Lanka (NHSL). Methods: Patients undergoing elective surgery at seven general surgical units of the NHSL from January-Februaary 2009 were included. NICE-UK guidelines on pre-operative investigation was the standard of assessment. Data on preoperative investigations were collected using an expert validated pre-tested interviewer administered questionnaire. A self-administered questionnaire was used to assess the ward practices and House Officers’(HOs) knowledge. Results: Sample size was 367. Mean age 45.7±15.8 years and males were 46.9%. Majority were ASA-I (68.7%) and surgical grade-II (56.7%). Urinalysis and arterial blood gases demonstrated good adherence (70%-100%) to guidelines. Electrocardiography, full blood count, renal functio