BACKGROUND AND PURPOSE:

• Current preop guidelines (American Surgical Association) advise as follows
  • Routine hemoglobin/hematocrit and chemistry testing before surgery is not recommended | Should be reserved for certain preexisting conditions
• However, approximately 90% of women undergoing benign gyn surgery undergo ≥1 such routine tests
• Geynisman-Tan et al. (Female Pelvic Medicine & Reconstructive Surgery, 2020) sought to determine how often routine preoperative laboratory testing prior to urogynecologic surgery yielded useful meaningful results

METHODS:

• Retrospective cohort study (2014 to 2017)
• Participants
  • All reconstructive pelvic surgery cases
  • Major cases: Vaginal or laparoscopic apical prolapse repair with/without hysterectomy | Laparotomy | Fistula repair
  • Minor cases: Midurethral sling | Isolated colporrhaphy | Diverticulectomy | Sacral nerve stimulator implant
• Study design
  • Women undergoing major surgery routinely had
    • A basic metabolic panel
    • Complete blood count (CBC), type, and screen
  • Women undergoing minor surgery had
    • Testing at the surgeon’s discretion
• Meaningful abnormality definition
  • Hbg level <10 mg/dL | Plt count <100 x 10³/mL | Creatinine level >1.0 mg/dL | Sodium level <135 mEq/L | Potassium level >3.6 mEq/L | Glucose level >200 mg/dL
• If testing revealed a clinically meaningful abnormality, physician notes were reviewed to determine whether the abnormality
  • Was previously known
  • Led to surgical postponement

RESULTS:

• 836 cases were reviewed
  • Major surgery: 49%
  • Minor surgery: 51%
  • Mean: 57 years
  • Mean BMI: 27 kg/m2
• Comorbidities
  • Hypertension: 38%
  • Diabetes: 24%
  • Chronic kidney disease: 3%
  • Congestive heart failure: 4%
• Preoperative Laboratory testing
  • CBC: 54%
  • Basic metabolic panel: 44%
• Laboratory testing findings
  • New abnormalities identified on CBC: 6 women
    • All were Hgb between 8.0 and 10.0
  • Elevated creatine level (>1.0): 31 women
    • 90% of these cases had a history of hypertension
• No surgeries were postponed or changed due to anemia, thrombocytopenia, or renal dysfunction
• No clinically significant electrolyte abnormalities were identified
• Type and screen were collected on 394 patients (47%)  
  • No patients were transfused intraoperatively
  • 1 patient received postoperative, nonemergent transfusion

CONCLUSION:

• Routine preoperative laboratory testing for women undergoing urogynecologic surgery did not identify clinically meaningful abnormalities
• Laboratory testing did not alter surgical management
• The authors state

…urogynecologic surgeons in our department no longer order preoperative laboratory testing on any patients and defer all testing to the preanesthesia clinic

Type and screens are no longer ordered by the surgeons or anesthesiologists for urogynecologic patients

Learn More – Primary Sources:

Clinical Utility of Routine Preoperative Laboratory Assessment in a Urogynecologic Population

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