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ECONOMICS AND HEALTH SYSTEMS RESEARCH

The Prevalence and Predictive Value of Abnormal Preoperative Laboratory Tests in Elderly Surgical Patients

Department of Anesthesia and Perioperative Care, University of California, San Francisco

Address correspondence and reprint requests to Dr. Leung, University of California, San Francisco, Mount Zion Medical Center, Department of Anesthesia and Perioperative Care, 1600 Divisadero St., San Francisco, CA 94143-1605. Address e-mail to jmleung @itsa.ucsf.edu.

Because data to determine which preoperative laboratory tests are important in elderly surgical patients are limited, we performed a prospective cohort study to evaluate the prevalence and predictive value of abnormal preoperative laboratory tests in consecutive patients 70 yr old who were undergoing noncardiac surgery. Patients presenting for surgery requiring only local anesthesia or monitored anesthesia care were excluded. Preoperative risk factors and laboratory test results were measured and evaluated for their association with the occurrence of predefined in-hospital postoperative adverse outcomes. In 544 patients, the prevalence of preoperative electrolytes and platelet count abnormalities (<115 x10⁹/L) was small (0.5%–5%), and abnormal creatinine (>1.5 mg/dL), hemoglobin (<10 g/dL), and glucose (>200 mg/dL) values were 12%, 10%, and 7%, respectively. Univariate predictors for adverse outcome of abnormal sodium and creatinine were not as predictive as ASA classification and surgical risk. By multivariate logistic regression, only ASA classification (>II) (odds ratio [OR], 2.55; 95% confidence interval [CI], 1.56–4.19; P < 0.001) and surgical risk (OR, 3.48; 95% CI, 2.31–5.23; P < 0.001) were significant independent predictors of postoperative adverse outcomes. The prevalence of abnormal preoperative electrolyte values and thrombocytopenia was small and had low predictive values. Although more prevalent, abnormal hemoglobin, creatinine, and glucose values were also not predictive of postoperative adverse outcomes. Routine preoperative testing for hemoglobin, creatinine, glucose, and electrolytes on the basis of age alone may not be indicated in geriatric patients. Rather, selective laboratory testing, as indicated by history and physical examination, which will determine patient’s comorbidities and surgical risk, seems to be indicated.

IMPLICATIONS: The prevalence of abnormal preoperative electrolyte values and thrombocytopenia was small and had low predictive values. Although more prevalent, abnormal hemoglobin, creatinine, and glucose values were also not predictive of postoperative adverse outcomes. Routine preoperative testing for hemoglobin, creatinine, glucose, and electrolytes on the basis of age alone may not be indicated in geriatric patients. Rather, selective laboratory testing, as indicated by history and physical examination, which will determine patient’s comorbidities and surgical risk, seems to be indicated.

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