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BMJ Open. 2019 Nov 27;9(11):e032306. doi: 10.1136/bmjopen-2019-032306.

Use of preoperative haemostasis and ABO blood typing tests in children: a retrospective observational study using a nationwide claims database in Japan.

Author information

1
Department of Clinical Anesthesiology, Mie University Graduate School of Medicine, Tsu, Mie, Japan komekurahiroshi@gmail.com.
2
Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Kyoto, Japan.
3
Department of Otolaryngology, Shiga Medical Centre for Children, Moriyama, Shiga, Japan.
4
Department of Clinical Anesthesiology, Mie University Graduate School of Medicine, Tsu, Mie, Japan.

Abstract

OBJECTIVES:

To describe the prevalence and factors associated with preoperative haemostasis and ABO blood typing tests for children because these tests might represent low-value care.

DESIGN:

A retrospective observational study.

SETTING:

Nationwide insurance claims database in Japan.

PARTICIPANTS:

Patients aged 1-17 years who underwent common non-cardiac surgeries between April 2012 and March 2018 were included. Patients with high-risk comorbidities for bleeding (n=175) and those with multiple eligible surgeries were excluded (n=2121).

MAIN OUTCOME MEASURES:

We described the proportions of each preoperative test performed within 60 days before an index surgery, including platelet count, prothrombin time (PT), activated partial thromboplastin time (aPTT) and ABO blood typing tests. We also explored the associations between patient-level and institutional-level factors and any preoperative tests, using multilevel logistic regression analysis.

RESULTS:

We included 13 018 patients (median (IQR) age, 5.2 (2.9-7.7) years; 8276 (63.6%) boys) from 1499 institutions. The overall proportion of each test was as follows: platelet count, 78.6%; PT, 54.4%; aPTT, 56.4% and ABO blood typing tests, 50.4%. The proportion of patients undergoing any preoperative tests in the overall sample was 79.3%. Multilevel logistic regression analysis indicated that preoperative tests were associated with type of anaesthesia (general anaesthesia: adjusted OR 7.06; 95% CI 4.94 to 10.11), type of surgery (tonsillectomy: adjusted OR 3.45; 95% CI 2.75 to 4.33) and surgical setting (inpatient procedure: adjusted OR 5.41; 95% CI 3.83 to 7.66). There was one postoperative transfusion event (0.008%) in the entire cohort and 37 postoperative reoperation events for surgical bleeding after tonsillectomy (0.90%).

CONCLUSIONS:

In the largest Japanese cohort reported to date, preoperative haemostasis and ABO blood typing tests were performed in a majority of children prior to common paediatric surgeries. Preoperative tests were associated with anaesthesia, surgical type and surgical setting.

KEYWORDS:

blood typing test; haemostasis test; overuse; paediatrics; preoperative test

Conflict of interest statement

Competing interests: KK received honoraria from Shin Nippon Biomedical Laboratories; research funds from Bayer Yakuhin, CMIC, Novartis Pharma K.K., Suntory Beverage & Food, Dainippon Sumitomo Pharma and Stella Pharma; and holds stocks in School Health Record Center and Real World Data. There are no patent products under development or marketed products to declare, relevant to those companies.

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