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Overuse of preoperative laboratory coagulation testing and ABO blood typing: a French national study

Abstract : Background: Following publication of guidelines on routine preoperative tests, the French Society of Anaesthesiology and Intensive Care (SFAR), in association with French national public health insurance, conducted a survey to evaluate adherence to guidelines and the economic consequences. Methods: Using the French Hospital Discharge Database and National Health Insurance Information system, tests performed during the 30 days before surgery were analysed for two situations: (1) standard laboratory coagulation tests and ABO blood typing in children able to walk and scheduled for tonsillectomy/adenoidectomy; and (2) ABO blood typing in adults before laparoscopic cholecystectomy, thyroidectomy, lumbar discectomy or breast surgery. Guidelines do not recommend any preoperative tests in these settings. Results: Between 2013 and 2015, a coagulation test was performed in 49% of the 241 017 children who underwent tonsillectomy and 39% of the 133 790 children who underwent adenoidectomy. A similar pattern was observed for ABO blood typing although re-operation rates for bleeding on the first postoperative day were very low (0.12-0.31% for tonsillectomy and 0.01-0.02% for adenoidectomy). Between 2012 and 2015, ABO blood typing was performed in 32-45% of the 1 114 082 patients who underwent one of the four selected procedures. The transfusion rate was very low (0.02-0.31%). The mean cost for the four procedures over the 4 yr period was €5 310 000 (sd €325 000). Conclusions: Standard laboratory coagulation tests and ABO blood typing are still routinely prescribed before surgery and anaesthesia despite current guidelines. This over-prescription represents a high and unnecessary cost, and should therefore be addressed.
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Contributor : Laurent Jonchère Connect in order to contact the contributor
Submitted on : Thursday, January 11, 2018 - 11:22:39 AM
Last modification on : Wednesday, March 30, 2022 - 2:34:05 PM

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H. Beloeil, D. Ruchard, N. Drewniak, S. Molliex. Overuse of preoperative laboratory coagulation testing and ABO blood typing: a French national study. British Journal of Anaesthesia, 2017, 119 (6), pp.1186-1193. ⟨10.1093/bja/aex268⟩. ⟨hal-01680958⟩



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