Anesthetic Considerations for Patients with Abnormal Routine Preoperative Test Findings

Abstract

Background: Routine preoperative laboratory testing is widely practiced in elective surgery, yet its clinical utility and cost-effectiveness remain controversial, especially for asymptomatic and low-risk patients. The literature highlights a gap in understanding the true impact of abnormal preoperative findings on perioperative management and outcomes. Objective: This study aimed to determine the prevalence and clinical relevance of abnormal routine preoperative test findings in elective surgical patients, assess their impact on perioperative management, and identify patient characteristics associated with clinically significant abnormalities. Methods: A retrospective cross-sectional observational study was conducted at Social Security Hospital Multan Chungi, Lahore, Pakistan, analyzing records of 80 adult patients (n = 80) who underwent elective surgery from December 2024 to March 2025. Inclusion criteria were age 18–65 years, non-emergency surgery, general or regional anesthesia, and at least one abnormal preoperative test (CBC, ECG, CXR, urinalysis, coagulation profile, electrolytes, creatinine, or HbA1c). Exclusion criteria included emergency surgery, incomplete records, and local/MAC anesthesia. Data were extracted from hospital files and anesthetist questionnaires, with outcome measures including prevalence of abnormal findings, perioperative management changes, and complication rates. Statistical analysis was performed using SPSS 27.0, employing descriptive statistics and Chi-square tests; significance was set at p < 0.05. Ethical approval was obtained in accordance with the Helsinki Declaration. Results: Abnormal preoperative findings were highly prevalent, with multiple abnormalities present in 81.3% of patients. However, only 19.5% of these findings led to significant changes in perioperative management (χ² = 23.00, p < .001, Cramer’s V = 0.54). Preference for regional anesthesia was strong in patients with significant abnormalities (90%, χ² = 56.13, p < .001). Perioperative complications were most commonly hypotension and arrhythmias (45%), but all patients with abnormal findings were managed without excess morbidity. Older age (≥ 60 years) and higher ASA class were associated with clinically significant abnormalities. Conclusion: Most abnormal routine preoperative test findings in elective surgical patients do not alter perioperative management, supporting a shift toward individualized, risk-based preoperative assessment. Adopting selective testing protocols aligned with clinical history and surgical risk optimizes patient safety and resource utilization, with implications for improved healthcare efficiency and reduced unnecessary interventions.