Page 21 - World Journal of Laparoscopic Surgery

WJOLS

Coagulation Profile is Randomly done but never Helps in Preparation of Laparoscopic Surgery

Table 4: Summary of the coagulation profile results (p < 0.01)
Test indicated Screening test
Normal Total abnormal Abnormal with intervention Normal Total abnormal Abnormal with intervention
73 14 5 455 8 0
83.91% 16.09% 5.75% (35.71%)* 98.27% 1.73% —
Total number of patients = 87 (15.82%) Total number of patients = 463 (84.18%)
*35.71% of abnormal results (5 of 14) needed intervention which were 5.75% of total (5 of 87)

Table 5: Available postoperative coagulation profile results (p < 0.01)
Test indicated group Screening test group
Normal Total abnormal Abnormal with intervention Normal Total abnormal Abnormal with intervention
36 9 4 110 3 0
Total number of patients = 45 Total number of patients = 113

international guidelines CAS, ASA and Harvard medical could have influenced our test of significance. Most of
school study to keep the evaluation process simple and our patients are female 461 (83.82%) this was because
which can be a tool for the surgeon and anesthetist for gynecological laparoscopic procedures 224 (40.73%)
preoperative assessment of patient in future. When these were included in the study. Moreover, our single most
criteria were applied to the general, gynecological and performed surgery was laparoscopic cholecystectomy
urological elective surgery patients who had been ope- which was also overtly dominated by female. We found
rated laparoscopically, 87 (15.82%) of them had at least a relatively high number of abnormal results in the
one indication for the test. In 84.18% (463) of the patient screening test groups because we followed our local
test were not indicated were truly screening tests for an hospital definitions of abnormal results, rather than the
occult coagulopathy because they could not have been more practical ‘action limits’. We also considered total
otherwise suspected. Although 1.73% of the screening test result as abnormal when any component of the test
tests were abnormal, all ignored by the surgeon and breached the reference value. For instance, we labeled
anesthetist, because they were marginally prolonged. total coagulation profile as abnormal when any one of
Literature also suggests that minimally deranged coagu- PT, APTT, INR, BT or PC being abnormal, As such, very
lation result have a poor predictive value for a surgically few actual interventions were needed for these abnormal
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significant coagulopathy. Following an abnormal test results. We considered the change of management plan
result clinicians may go for correction of it, whereas a seri- named as intervention to differentiate between the results
ous abnormality may suggest the surgery to be cancelled of two groups, as minor change of test value has no real
or delayed. But commonly most abnormalities are simply benefits to calculate. Test values also fluctuate by reagent
ignored. As per Roizen MF clinicians ignore more than used and analyzer machines.
60% of abnormalities discovered on routine preopera- In summary, we could not appreciate any special clue
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tive tests. In our patients, 35.71% of abnormal results in or danger to carry on with the same traditional practice
indicated test group were taken for active management of routine preoperative coagulation tests for laparoscopic
by the physicians others were simply ignored, whereas procedures. The results of our study show that most
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all the abnormal results were amenable to overlook in tests 84.18% (463, Table 4) ordered at our institution are
screening test group. incompatible with the applicable published guidelines.
Postoperatively (up to 28 days), some patients with To follow established guidelines is usually the exception
major surgery and had to stay in hospital for couple of and not the rule in the majority of health institutions in
days, found to have repeat coagulation profile. Again there the World. This failure to convert recommendations into
was no intervention identified in screening test group in practice is often not related to the content or quality of
comparison to four interventions in patients of indicated the guidelines themselves but is more related to difficulty
test group. We did not put emphasis on these findings in changing established behavior of clinicians and institu-
our study as all the patient had not gone through the same tions in addition to failure of dissemination, cost, and
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investigations after operation, although it gave an idea that doubt of guideline’s applicability in local populations.
illogical coagulation profile has no role in laparoscopic We hope that our study result will be a guideline for
surgical procedures even in postoperative period. asking coagulation profile tests in KSA as well as
Our study is retrospective; our control and study Bangladesh which will reduce the unnecessary financial
groups were not matched in number, age and sex, which burden on the society and patients.

World Journal of Laparoscopic Surgery, January-April 2015;8(1):16-20 19