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COST SAVING OF ELIMINATION OF LABORATORY TESTS IN AMBULATORY CATARACT SURGERY

Department of Anesthesiology, Toronto Western Hospital, University Health Network, University of Toronto, 399 Bathurst St., Toronto, Ontario, Canada, M5T 2S8

INTRODUCTION

Schein et al following a study of 19,557 cataract surgeries, recommended that cataract patients should not have routine tests done; only tests indicated by history and physical examination. Our hospital introduced a policy to eliminate routine tests for cataract patients on February 1, 2001. The purpose of this study is to evaluate the cost savings in laboratory tests before and after policy introduction.

METHODS

Institutional Research Ethics Board approval was obtained. The policy stated that no routine tests should be ordered by the surgeons. Patients with medical problems were referred to the anesthesiologist who would order tests as indicated. Anesthesia was with local (topical or retrobulbar block) and sedation. Patient demographics, clinical, laboratory tests and morbidity data were collected in consecutive cataract patients in a four-month period in 2000 (Group 1: before policy) and 2001 (Group 2: after policy). The cost of individual tests was ascertained from the hospital finance department. The number and cost of laboratory tests per patient between groups were compared. Student's t test was used for continuous data while Chi square was used for categorical data. P< 0.05 was accepted as significant.

RESULTS

A total of 1,231 patients were included in the study, 636 in group 1 and 595 in group 2. There was no difference in co-morbidities, ASA status, and preoperative medication use between the groups. There was over 90% cost savings (group 1 $34.20 vs group 2 $3.00) per patient. There was a statistically significant reduction in number of tests and cost of tests per patient without any difference in morbidity between the groups.

Group 1 Group 2 PREOP TESTS (ORDERED) % Patients % Patients Complete Blood Count 93.5 5.9 Electrolytes 69.7 4.3 Creatinine / Urea 60.5 4.3 Glucose 37.7 2.2 Electrocardiogram 94.7 7.2 Patients with no tests 2.7 89.4

CONCLUSION

Over 90% in potential cost savings was possible by eliminating routine preoperative tests in cataract patients, without adversely affecting morbidity and mortality. Further studies are required to assess whether the same preoperative testing policy could be extended to other low risk surgeries.

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