Rev Bras Anestesiol 2018 Mar - Apr;68(2):154-161. Epub 2017 Nov 12.
Instituto Brasileiro de Controle do Câncer, São Paulo, SP, Brasil.
Background And Objective: There are few data defining the period of time in which preoperative tests can be considered valid. The purpose of this study was to determine the likelihood of changes in the results of preoperative tests previously normal in relation to time, and the impact of these changes on postoperative outcomes.
Methods: A total of 970 patients with normal preoperative tests before the first surgery and who required a new intervention were included. The preoperative tests performed for the first procedure were compared with those performed for the second procedure. The following variables were assessed regarding their potential to induce changes in test results: sex, age, surgical risk, previous chemotherapy or radiotherapy, and presence of comorbidities. In-hospital outcomes were analyzed.
Results: The median time between procedures was 27 months (6-84). The probability of change in at least one of the preoperative exams was 1.7% (95% CI: 0.5-2.9), 3.6% (95% CI: 1.8-5.4), and 6.4% (95% CI: 3.9-8.9) during the 12, 24, and 36-month intervals, respectively, for patients aged <50 years and 2.1% (95% CI: 0.7-3.5), 9.2% (95% CI: 5.9-12.5), and 13.4% (95% CI: 9.3-17.5), respectively, for patients ? 50 years of age. Age (p=0.009), surgical risk (p <0.001), chemotherapy (p=0.001), radiotherapy (p=0.012), and comorbidities (p <0.001) were associated with the likelihood of changes in test results. Test changes were not significantly associated with in-hospital adverse outcomes (p=0.426).
Conclusion: For patients undergoing a second surgical procedure, the probability of change in previously normal preoperative tests is low during the first years after the first surgical intervention, and when changes occurred, they did not adversely affect the in-hospital postoperative outcomes.
L.W. Ramos, I.W.H. Dias, R.G. Oliveira, E. Elly, E. Castilho, B. Cristina, M. Wolf, M.A. Calil, J.C.S. Goes, Is there a validity time for normal preoperative tests for another surgical intervention?, European Heart Journal, Volume 34, Issue suppl_1, 1 August 2013, P3350
European Heart Journal
Purpose: Cardiologists are frequentely requested to perform the preoperative clinical evaluations prior to non-cardiac surgery.Several preoperative tests are routinely ordered to evaluate the clinical condition of the patient. On average, half of the patients have normal results. Since a paucity of data exists that delimits the validity period of these tests, they are frequently repeated in a matter of months if a second surgery is scheduled; thus, raising healthcare cost and the time before the second surgery can be performed. The aim of this study was to determine the temporal probability for change in normal preoperative tests and its relation to in-hospital evolution.
Methods: A total of 1,034 patients (946 female; 49.7±12.3 years) with a neoplasm, who required surgical reintervention under general anesthesia were evaluated. All the patients were submitted for complete preoperative tests on both interventions, which included an ECG, chest X-ray, and blood tests. All patients had normal tests at the first intervention. The tests for the first intervention were compared with those of the second. The patients were divided in two groups: up to and over 50 years. The possible contribution of the following factors was analyzed as test modification determinants: age; surgical risk (ASA); prior chemotherapy (QT) or radiotherapy (RXT); and presence of co-morbidities. In-hospital evolution was followed.
Results: The mean interval between procedures was 41.2±32.7 months (6-191 months). From total of sample, the probability of change in any one of the tests was 1.4% (CI 0.6-2.2) for 12 month interval, 4.6% (CI 3.2-6.0) for a 24 month interval, and 8.3% (CI 6.1-10.5) for a 36 month interval. The probability of change in any one of the tests was 1.6% (CI: 0.6-2.6) for a 12 month interval, 2.7% (CI: 1.1-4.3) for a 24 month interval, and 5.7% (CI: 3.3-8.1) for a 36 month interval for patients up to 50 years. For patients older than 50 years, the probability of change was 1.2% (CI; 0.2-2.2) for a 12 month interval, 7.1% (CI: 4.4-9.8) for a 24 month interval, and 11.9% (CI: 8.2-15.6) for a 36 month interval. Among the variables analyzed, age (P = 0.001), surgical risk (P < 0.001), QT (P = 0.001), RXT (P = 0.002), and co-morbidities (P < 0.001) correlated with the probability of test changes. No correlation was found between in-hospital outcome and the presence of test changes.
Conclusions: Our results demonstrate that the probability preoperative test changes during the initial postoperative years are rare; furthermore, when they occur, they do not have any significant impact on the postoperative outcome.