Evaluating the clinical relevance and cost effectiveness of routine pre-operative investigation in elective surgeries: A prospective observational study

The study will comprise individuals who will attend a pre-anaesthesia check-up(PAC) prior to surgery in the preoperative ward for evaluation and risk stratification before planned elective procedures. Their demographic information, date of arrival in pre-anaesthesia check-up (PAC), American Society of Anaesthesiologist’s (ASA) status, and grade of surgery according to NICE guidelines 2016 will be documented. The participants will be randomly assigned using the envelope method. The number of investigations completed prior to arrival at pre-anaesthesia check-up (PAC), as well as the outcomes of normal and abnormal tests, will be recorded. A test will be judged abnormal if it does not fall within the normal limits established by the institutional laboratory. According to the criteria, the test will be classified as indicated or unindicated. The number of abnormal tests and their significance will be expressed. All the patients will be followed up on subsequent pre-anaesthesia check-up (PAC) visits till one day prior to surgery and the total no. of pre-anaesthesia check-up(PAC) visits, any referral, further investigation and consequent delay will be confirmed pre-operatively. In the post-operative period, changes in the on-going management, alteration in the anaesthetic procedures, or monitoring plan will be noted. An abnormal test was considered impactful if it led to further evaluation, and significant if it altered perioperative management. Unnecessary tests, based on NICE guidelines, will be analyzed for cost implications. Diagnostic investigations will be excluded from this study. Any disease-specific investigation conducted based on a significant patient’s history or clinical investigations will not be regarded significant as they will not constitute regular investigations. A single anaesthesiologist will be responsible for collecting data throughout the trial. The designated anaesthesiologist will not be allowed to filter investigations or intervene in the pre-anaesthesia check-up (PAC) process of colleagues of similar rank. To avoid bias, the surgeon and anaesthesiologist will not be informed about the study. Patients examined by the designated anaesthesiologist will be excluded from the research.