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Comput Math Methods Med. 2017;2017:3624075. doi: 10.1155/2017/3624075. Epub 2017 Dec 7.

Influence of Institution-Based Factors on Preoperative Blood Testing Prior to Low-Risk Surgery: A Bayesian Generalized Linear Mixed Approach.

Author information

1
Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshida-konoecho, Sakyo-ku, Kyoto 606-8501, Japan.
2
Center for the Promotion of Interdisciplinary Education and Research, Kyoto University, Yoshida-honmachi, Sakyo-ku, Kyoto 606-8501, Japan.
3
Clinical Research Center, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba 260-8677, Japan.

Abstract

To optimize delivery of health care services in clinical practice, the use of unnecessary interventions should be reduced. Although recommendations for this reduction have been accepted worldwide, recent studies have revealed that the use of such procedures continues to increase. We conducted a retrospective cohort study using a nationwide claim-based database to evaluate factors influencing preoperative blood testing prior to low-risk surgery, via a Bayesian generalized linear mixed approach. The study period was set from April 1, 2012, to March 31, 2016, and 69,252 surgeries performed at 9,922 institutions were included in the analysis. Mean patient age was 44.3 ± 11.3 years (57% female). Preoperative blood tests were performed for 59.0% of procedures. Among institutional factors, the number of beds was strongly associated with preoperative blood testing (odds ratio [95% highest posterior density interval (HPD interval)], 2.64 [2.53 to 2.75]). The difference (95% credible interval) in the rate of preoperative blood testing between institutions with <100 beds and ≥100 beds was 0.315 [0.309 to 0.322], and the Bayesian index θ was 1.00. This indicated that preoperative blood tests are strongly influenced by institutional factors, suggesting that specific guidelines should be developed to avoid excessive preoperative testing for low-risk surgery.

PMID:
29362591
PMCID:
PMC5738628
DOI:
10.1155/2017/3624075
[Indexed for MEDLINE]
Free PMC Article

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