The impact of routine preoperative complete blood count (CBC) in elective operations in Srinagarind Hospital.

Because anemia and infectious diseases are still common, routine preoperative complete blood count (CBC) is often performed in most teaching hospitals in Thailand. However, there is growing consensus that it is of little benefit. We studied prospectively all patients who were scheduled for elective operation in Srinagarind Hospital. Medical history and physical examination were obtained prospectively without knowing the CBC result. Out of 1,013 patients interviewed, 955 were suitable for study, 384/955 (40.2%) of the CBC were abnormal. Significant anemia (hematocrit less than 30%) was found in 42 (4.4%), leukocytosis in 113 (11.8%), inadequate platelet in 3 (0.3%). The CBC abnormalities led to a change in management in 38 (4.0%). The clinical predictors of CBC abnormalities included weight loss, history of fever, presence of anemia and tender abdomen. In those with normal history and physical examination, the prevalence of anemia and CBC which led to management change was less than 1.7 per cent, regardless of age.

A study of unit cost of routine investigations in Srinagarind Hospital.

We have used the step up allocation accounting method to determine the actual costs of complete blood count, urinalysis, chest radiograph and electrocardiogram. We found that the actual costs were quite different from the price set up by the hospital. The actual cost were much higher than the price for the complete blood count and urinalysis and much lower for the chest radiographs and especially for electrocardiogram. We propose that in performing economic analysis involving all these investigations, the actual cost should be used instead of the price.

The impact of routine preoperative electrocardiogram in patients age > or = 40 years in Srinagarind Hospital.

A 12 lead electrocardiogram (ECG) has been recommended for adult patients before operations involving general or regional anesthesia. However, there is a growing consensus that it is of little benefit and ECG should be done only in selected subsets of patients with cardiac signs and symptoms or older patients. We prospectively surveyed 1,013 patients before operation, 395 patients were 40 years or more, ECG abnormalities were present in 130/395 (32.9%), significant ECG abnormalities in 31/395 (7.9%) and ECG with management change in 10/395 (2.5%). Old or questionable myocardial infarction were found in 8 (4.0%) and acute ischemia or injury in 4 (2.0%). The frequency of ECG abnormalities increased with age in males but not in females. Abnormal physical examination could predict only 20 per cent of abnormal ECG. The variables which could predict ECG abnormalities were age and irregular pulse. The frequency of ECG abnormalities, significant ECG abnormalities and ECG abnormalities which led to management change in those patients with normal physical examination were 31.7, 6.4 and 2.2 per cent respectively. In conclusion we propose that preoperative ECG may be indicated in both men and women aged > or = 40 years.