Adopting Information Management Based Joint Preoperative Assessment and Risk Stratification Model to Save Surgical Care Cost

Preoperative assessment and risk stratification is an integral part of anesthetic care which is one of the various duties of an anesthesiologist. Laboratory investigation is an important element in the process of preoperative assessment and risk stratification. Unfortunately, despite of having negative recommendations for routine preoperative testing for more than a decade, it still remains a tradition in health care delivery for surgical patients[1,2]. The health care cost is becoming an increasing burden for every nation, especially for developing and underdeveloped countries. Studies conducted on cost savings have shown that 63% of the total cost of the tests was due to unnecessary tests[3,4]. Preoperative testing is estimated to cost US$ 18 billion annually in United Sates alone[5]. Efforts have been made by different health care societies and authorities to guide the preoperative testing before elective surgeries. American Society of Anaesthesiologists and the National Institute of Health and Clinical Excellence guidelines on preoperative testing are notable among them[1,6]. Unfortunately, the tradition of ordering routine preoperative tests is very much prevalent in clinical practice. Many of the tests ordered are actually unnecessary or unindicated, thus a good amount of cost saving is possible by avoiding such wrong traditional practice of routine testing[3,7-9]. In preoperative risk assessment, the history and physical examination are the strongest predictors of perioperative complications. Ancillary tests should be indicated on an individual basis if the history and physical examination indicate towards some underlying disease[10]. However, studies show that the practice has not changed to ‘individualized / patients characteristic' from ‘routine' and that preoperative testing is more strongly associated with provider practice patterns than with patient characteristics[11]. A study reviewing data from National Surgical Quality Improvement Program database found that neither laboratory testing nor abnormal results were associated with postoperative complications[12]. Many a time, we try to find some hidden abnormality by using routine preoperative testing. What we need to realize is that routine screening does not improvepatient safety in the perioperative period. It is also necessary to differentiate between global screening method and preoperative risk evaluation. If the screening examination needs to be carried out, it should be independent of a planned surgery[13]. Although preoperative risk evaluation can, it should not fill this “gap” of screening examination[13].