The unproven utility of the preoperative urinalysis: economic evaluation

Journal of Clinical Epidemiology
V A LawrenceM Gross

Abstract

The clinical effectiveness of the preoperative urinalysis is unproven, yet it is routinely obtained before surgery. To determine if the routine urinalysis might be economically beneficial, we evaluated its cost-effectiveness and cost-benefit. In the setting of elective clean-wound, non-prosthetic knee procedures, we estimated that: (1) nearly U.S. $7,000,000 is spent annually on preoperative urinalyses and associated costs; (2) given the best estimate of the increase in risk of wound infection attributable to urinary tract infection, 4.58 wound infections may be prevented annually, at a cost of $1,500,000 per wound infection prevented; (3) the cost of treating additional cases of wound infection, given no preoperative urinalysis, is approximately five hundred-fold less than the cost of screening with routine urinalyses. We conclude that the routine preoperative urinalysis is clinically and economically unsound before clean-wound, non-prosthetic knee surgery and probably before other types of clean-wound surgery. For this relatively inexpensive test, aggregate costs are disproportionately high and appear to outweight clinical benefits.

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Citations

Nov 18, 1997·Arthritis Care and Research : the Official Journal of the Arthritis Health Professions Association·H S RuchlinJ P Allegrante
Jul 5, 2002·World Journal of Surgery·Kwok F J NgSuk F Tsang
Mar 19, 2002·International Anesthesiology Clinics·L Reuven Pasternak
Dec 24, 2013·The Journal of Arthroplasty·Vinay K AggarwalWilliam Charles Watters
May 22, 2010·Anesthesiology Clinics·Deborah C Richman
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Nov 26, 2009·The Journal of Bone and Joint Surgery. American Volume·UNKNOWN American Academy of Orthopaedic Surgeons Patient Safety Committee, Richard P Evans
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Feb 11, 2003·The Medical Clinics of North America·Gerald W Smetana, David S Macpherson

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