Rajajee Selvam1, Amer Jarrar2, Cynthia Meghaizel2, Joseph Mamazza2, Amy Neville2, Caolan Walsh2, Nicole Kolozsvari2. 1. Division of General Surgery, Department of Surgery, The Ottawa Hospital, Civic Campus, Loeb Research Building, 725 Parkdale Avenue - Office WM150B, Ottawa, ON, K1Y 4E9, Canada. rselvam@toh.ca. 2. Division of General Surgery, Department of Surgery, The Ottawa Hospital, Civic Campus, Loeb Research Building, 725 Parkdale Avenue - Office WM150B, Ottawa, ON, K1Y 4E9, Canada.
Abstract
BACKGROUND: A quality improvement opportunity was identified to de-adopt the low-value care practice of routinely performing bloodwork for all patients undergoing elective bariatric surgery. While these patients are typically discharged on postoperative day 1 (POD1) after bloodwork is performed, it is uncommon for the discharge plan to change due to unexpected laboratory abnormalities alone. METHODS: Patients undergoing bariatric surgery between September 2020 and April 2021 only had POD1 bloodwork if there were perioperative clinical concerns, they had insulin-dependent diabetes, or they were therapeutically anticoagulated. Thirty-day Emergency Department (ED) visits and readmissions were monitored as balancing measures. Outcomes were compared to a control group that underwent bariatric surgery prior to September 2020 when POD1 laboratory testing was routinely performed. Financial and environmental costs were estimated based our institutional standards. RESULTS: The intervention group consisted of 303 patients: 248 (82%) Roux-en-Y gastric bypasses and 55 (18%) sleeve gastrectomies. Most patients (n = 256, 84.5%) did not have POD1 bloodwork. Twelve (3.9%) had bloodwork performed in violation of our protocol, of which none had a change in management based on the results. Of the 35 (12%) who had appropriately ordered bloodwork, 6 (2%) required a transfusion and 2 (0.7%) required a second surgery on the same admission for hemorrhage. Forty-four (14.5%) had 30-day ED visits of which 17 (5.6%) were within 7 days. Sixteen (5.3%) were readmitted. There were no significant differences between intervention and control groups in the rate of transfusion, second surgery, or 30-day ED visits. The avoidance of POD1 bloodwork saved approximately $6602.24 in lab processing fees alone and 512 test tubes. CONCLUSION: POD1 bloodwork can be safely avoided in the absence of clinical concerns. In addition to not significantly increasing postoperative complications, there were benefits from a financial cost, environmental impact, and patient discomfort perspective.
BACKGROUND: A quality improvement opportunity was identified to de-adopt the low-value care practice of routinely performing bloodwork for all patients undergoing elective bariatric surgery. While these patients are typically discharged on postoperative day 1 (POD1) after bloodwork is performed, it is uncommon for the discharge plan to change due to unexpected laboratory abnormalities alone. METHODS: Patients undergoing bariatric surgery between September 2020 and April 2021 only had POD1 bloodwork if there were perioperative clinical concerns, they had insulin-dependent diabetes, or they were therapeutically anticoagulated. Thirty-day Emergency Department (ED) visits and readmissions were monitored as balancing measures. Outcomes were compared to a control group that underwent bariatric surgery prior to September 2020 when POD1 laboratory testing was routinely performed. Financial and environmental costs were estimated based our institutional standards. RESULTS: The intervention group consisted of 303 patients: 248 (82%) Roux-en-Y gastric bypasses and 55 (18%) sleeve gastrectomies. Most patients (n = 256, 84.5%) did not have POD1 bloodwork. Twelve (3.9%) had bloodwork performed in violation of our protocol, of which none had a change in management based on the results. Of the 35 (12%) who had appropriately ordered bloodwork, 6 (2%) required a transfusion and 2 (0.7%) required a second surgery on the same admission for hemorrhage. Forty-four (14.5%) had 30-day ED visits of which 17 (5.6%) were within 7 days. Sixteen (5.3%) were readmitted. There were no significant differences between intervention and control groups in the rate of transfusion, second surgery, or 30-day ED visits. The avoidance of POD1 bloodwork saved approximately $6602.24 in lab processing fees alone and 512 test tubes. CONCLUSION: POD1 bloodwork can be safely avoided in the absence of clinical concerns. In addition to not significantly increasing postoperative complications, there were benefits from a financial cost, environmental impact, and patient discomfort perspective.
Authors: Elizabeth P Howell; Beau J Kildow; Vasili Karas; Cynthia L Green; Daniel J Cunningham; Sean P Ryan; Michael P Bolognesi; Thorsten M Seyler Journal: J Arthroplasty Date: 2019-03-12 Impact factor: 4.757
Authors: Daniel J Niven; Kelly J Mrklas; Jessalyn K Holodinsky; Sharon E Straus; Brenda R Hemmelgarn; Lianne P Jeffs; Henry Thomas Stelfox Journal: BMC Med Date: 2015-10-06 Impact factor: 8.775