P019: INVESTIGATING THE INCIDENCE OF PREOPERATIVE TYPE AND SCREEN IN PATIENTS UNDERGOING VASCULAR SURGERY
Song Hyon Pak, MD, Adrienne Warrick, MD; University of Florida College of Medicine - Jacksonville
Intro: Preop assessment & medical optimization of patients (pt) scheduled for elective procedures is paramount in achieving a high level of pt safety. Vascular surgery (VS) pts have pre-existing co-morbidities1 that confers a higher risk of complications. This study is aimed at examining the incidence of preop type & screen (T&S) performed at our institution for elective VS procedures over a year. MSBOS (maximum surgical blood order schedule) is an institution specific system to reduce unnecessary blood ordering & decrease hospital costs2. Our institution’s MSBOS guidelines state moderate to high risk VS procedures warrant preop T&S. We hypothesize that T&S is not being performed uniformly for pts receiving mod to high risk VS. Secondary hypotheses are that age & gender are confounding factors for whether or not pts receive T&S.
Methods: With IRB approval, a retrospective chart review was conducted for VS pts between Jan 1 - Dec 31, 2013. Info collected: date/type of surgery, pt age/sex, pre/postop Hgb levels, ASA class, if preop T&S was ordered/performed, ordering provider, if blood transfused intraop/postop. Exclusion criteria: emergent cases, ASA 5, age <18, outpt surgery, operations (ops) not in specifically studied subgroup. Primary outcome examined was if a T&S was performed appropriately (30 days prior to op – our institution’s policy).
Categorical variables were summarized & analyzed using Pearson’s Chi-square test. Continuous variables were summarized using means, standard deviations & analyzed using non-parametric Wilcoxon rank. Significant associations were further investigated using Bonferroni adjustment for pair-wise comparisons. All analyses were run in SAS® Version 9.4 for Windows.
Results: 224 pts were included in this study. 122 (54.5%) had T&S done preop & 102 (45.5%) did not. 78 pts had carotid/other endarterectomy, 63 had distal extremity bypass revascularization, 33 had hemodialysis access related surgery, 19 had aortic aneurysm surgery & 31 had an extremity amputation. Only 26 of 78 (33.3%) carotid/other endarterectomies had a preop T&S performed. 45 of 63 (71.4%) for distal extremity bypass had preop T&S, as did 14 of 19 (73.7%) aortic aneurysms. 23 of 31 (74.2%) undergoing amputations had preop T&S. Fig 1 displays these primary results. Pt gender did not have any statistical influence on whether or not T&S was performed (p= 0.148, tbl 1) & pt age did not have any statistical influence on T&S being performed (p=0.123, tbl 2).
Conclusions: Data collected from this study shows that not all mod to high risk VS pts receive preop T&S at our institution. Clinical opinion between surgeons may account for this. Mod to high risk VS like distal revascularization & aortic surgery should have preop T&S. Factorial analysis of data is ongoing to identify reasons for lack of uniformity. Future investigations will aim to improve pt care & safety practices. Findings & methods from this study may be used to investigate similar parameters in other subspecialties, especially in a cost reducing culture where unnecessary tests are avoided3.
1. Semin Vasc Surg 2014; 27:16-22
2. Anesth 2013; 118:1286-1297
3. Anesth 2012; 116:768-778