TY - JOUR
T1 - The unproven utility of the preoperative urinalysis
T2 - Economic evaluation
AU - Lawrence, V. A.
AU - Gafni, A.
AU - Gross, M.
PY - 1989
Y1 - 1989
N2 - 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 outweigh clinical benefits.
AB - 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 outweigh clinical benefits.
KW - Cost-benefit
KW - Preoperative screening
KW - Urinalysis
KW - Urinary tract infection
KW - Wound infection Cost-effectiveness
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U2 - 10.1016/0895-4356(89)90117-0
DO - 10.1016/0895-4356(89)90117-0
M3 - Article
C2 - 2511275
AN - SCOPUS:0024810918
VL - 42
SP - 1185
EP - 1192
JO - Journal of Clinical Epidemiology
JF - Journal of Clinical Epidemiology
SN - 0895-4356
IS - 12
ER -