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Poster Display - 14
Assessing the utility of routine preoperative complete blood count testing in children scheduled for surgical procedures in Pakistan: a quality improvement study
Zainab Haider 1, Muhammad Osama Khan 2, Humza Thobani 3, Javeria Javed 2, Rafia Durrani 2, Muhammad Aqil Soomro 2, Saqib Qazi 2, Faraz A . Khan 3, Saleem Islam 2
1 Medical College, Aga Khan University, Karachi, Pakistan
2 Section of Pediatric Surgery, Department of Surgery, Aga Khan University, Karachi, Pakistan
3 Division of Pediatric Surgery, Department of Surgery, Stanford University, Palo Alto, California
Purpose
Laboratory screening protocols may help identify and treat underlying health concerns before surgery to prevent complications, particularly in the low and middle income countries (LMICs). However, ineffective protocols may increase patient costs without benefit. Continuous audits are essential to identify and discontinue such protocols. We describe an audit of a preoperative screening protocol at an LMIC hospital.
Methods
This study was conducted at a tertiary care hospital in Karachi, Pakistan. Due to the assumed high prevalence of undernutrition and anemia, routine preoperative complete blood counts (CBCs) were performed in all pediatric surgical patients at our institution. We reviewed all surgical encounters in patients under 18 years in 2022. Clinical and demographic data were collected. Anemia and its severity were defined using WHO guidelines, and patients were stratified by age. Wilcoxon rank-sum and Chi-Square/Fisher’s exact tests were used as appropriate. A p-value < 0.05 was considered significant.
Results
A total of 798 patients were included out of which 540 (67.67%) were male. 479 (60.03%) underwent outpatient procedures while 319 (39.97%) were inpatient. Mean ages were 6.57±4.90 and 6.74±5.58 years in outpatient and inpatient groups respectively. Mean hemoglobin (Hb) was significantly lower in the inpatient group (11.67±5.78 vs. 11.75±1.48, p=0.0001). More inpatients received postoperative transfusions (53.3% vs. 0.2%, p<0.0001). Older patients (> 11 years) had the highest prevalence of anemia, a majority of which were moderate as per the WHO criteria. Anemia was significantly more prevalent in inpatients >5 years. No surgeries were delayed or preoperative transfusions were given based on screening CBC results.
Conclusion
Routine preoperative CBC did not alter management in our center. Older, sicker children undergoing inpatient surgery may be selectively screened. Eliminating CBCs in other cases can reduce patient burden. While standardized protocols are valuable, continuous auditing is crucial to ensure clinical benefit, especially in LMIC settings.