An Economic Evaluation of the Preoperative Investigations for Elective Surgical Patients at a Tertiary Care Hospital in Trinidad, West Indies

Objectives: The routine use of widespread laboratory investigations and ancillary tests in the preoperative period may lead to time delays as well as economic burden. This study aimed to identify the amount of unnecessary investigations and its costs in a tertiary care teaching hospital in the Caribbean.

Method: Patient and surgery specific data were collected prospectively from adult elective surgery patients over a three-month period during 2016. Surgical intensity, American Society of Anesthesiologists (ASA) grade, and National Institute for Health and Care Excellence (NICE) (UK, 2016) Clinical Guideline for Preoperative Investigations were used to determine the tests deemed as unnecessary. Using the cost estimation previously done by the Health Economics Unit, Trinidad & Tobago, the overall economic burden of unnecessary testing was estimated.

Results: Data were collected from 636 patients during the study period. Sixty-four percent of the preoperative investigations were deemed as unnecessary. Relatively healthier patients (ASA I and II) had significantly higher number of unnecessary investigations performed. The money spent on these investigations amounted to US $44,622. When extrapolated, this translated to approximately US$ 178,488 per annum. This represented 59% of the total money spent on the overall preoperative investigations performed.

Conclusion: This study clearly identified that the majority of preoperative investigations done on elective surgical patients may be unnecessary. This resulted in a huge economic burden for the healthcare system. There is a need to revisit the practice and stringently adopt the Clinical Guidelines for Preoperative Investigations.