Don’t obtain baseline laboratory studies in patients without significant systemic disease (ASA I or II) undergoing low-risk surgery–specifically complete blood count, basic or comprehensive metabolic panel, coagulation studies when blood loss (or fluid shifts) is/are expected to be minimal.

Rationale and Comments

Performing routine laboratory tests in patients who are otherwise healthy is of little value in detecting disease. Evidence suggests that a targeted history and physical exam should determine whether preprocedure laboratory studies should be obtained. The current recommendation from the 2003 ASA amendment that all female patients of childbearing age be offered pregnancy testing rather than required to undergo testing has provided individual physicians and hospitals the opportunity to set their own practices and policies relating to preoperative pregnancy testing. Some institutions respect the right of a patient to refuse testing after a thorough explanation of the anesthetic risks during pregnancy and the required signing of a waiver. The avoidance of the routine administration of the pregnancy test was therefore excluded from our top five preoperative recommendations. The risk specifically related to the surgical procedure could however modify the above preoperative recommendation to obtain laboratory studies and when the need arises; the decision to implement should include a joint decision between the anesthesiologists and surgeons. This should be applicable to all outpatient surgery.

Sponsoring Organizations

American Society of Anesthesiologists

Sources

American Society of Anesthesiologists guidelines

Disciplines

Surgical

References

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Mollov JL, Twersky RS. (2013). Is routine preoperative pregnancy testing necessary? In: Fleisher L. Evidence-based practice of anesthesiology (3rd ed., pp. 26-30). Philadelphia (PA): Elsevier Saunders.
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