1180 Indications for Day One Postoperative Blood Tests After Emergency Appendicectomy
J Kho, J Y Kuan, C Derbyshire, J Ward, I Rajendran- Surgery
Abstract
Aim
Appendicitis accounts for 47,000 admissions/year in England, and commonly involves patients aged 10 to 65 years. A cost-effectiveness study was conducted to assess the need for routine ‘day-one postoperative’ (D1) blood tests following ‘emergency appendicectomy’ (EA).
Method
Retrospective review of all EAs was carried out between January 2022 and October 2022. Data was collected from local hospital database. Elective appendicectomies were excluded. D1 blood tests were deemed necessary in complicated EAs, with clear documentation of the indication for blood tests. Costs of blood samples (FBC = £12, U&E, LFT and bone profile = £23 and CRP = £12) were verified by local/national (NICE and CCG) sources.
Results
Fifty EAs were reviewed. 39 (78%) cases were completed laparoscopically, 9 (18%) were laparoscopic converted to open and 2 (4%) were open appendicectomies. 36/50 (72%) patients had D1 bloods, 30 (83%) of which had an uncomplicated recovery. 6 (17%) patients developed postoperative complications; diabetic ketoacidosis (DKA) (n = 1), ileus (n = 2), superficial wound dehiscence (n = 1) and infected intra-abdominal collection diagnosed two weeks post-op (n = 2) (one patient was managed conservatively with intravenous antibiotics and the other underwent radiological-guided drainage). Only 1 (2%) patient (postoperative DKA) had a clear clinical indication for D1 bloods. This translates to potential cost savings of £2350.
Conclusions
Study demonstrates potential significant cost savings if clinicians rationalise blood test requests following EAs. These findings may be extended to other emergency and elective cases. In a resource-constrained environment, it is worth considering the need for postoperative tests, which could influence length of hospital stay and further cost savings.