Pre-Operative investigations for trauma patients: Are we doing it correctly?

Zina Jamil, Farook Zubair, Mina Farag

Introduction: Wrist and ankle fixations are the next most common trauma surgeries after hip fractures. Majority are operated as daycase procedures and discharged first day post-operation. It’s imperative to efficiently prepare patients pre-operatively and avoid unnecessary investigations that waste money, time and effort.

Aim: To analyse the trend of pre-operative blood investigations done for traumatic wrist and ankle fixations.

Method: Retrospective study done on wrist and ankle fixations at Dr. Gray’s Hospital between 01/01/2023 to 31/04/2024. Data was collected using Trakcare to register ASA level and bloods done including CBC, CRP, U&E, coagulation profile, and group and save. No standard pre-operative guidelines exist for trauma cases; hence we used pre-operative NICE guidelines for elective intermediate surgeries. Showed ASA 1 and 2 don’t need pre-operative bloods done except when indicated, while ASA 3 and 4 required all to be done.

Results: 93 patients registered, of ASA 1 and 2; 50 had ankle fixations of those 36 (72%) had CBC and U&E, 13 (26%) had coagulation profile where none were on anticoagulants, 26 (52%) had CRP and 24 (48%) G&S done. Whereas 27 patients had wrist fixations 8 (29.6%) had FBC and U&E, other bloods were insignificant numbers; ASA 1 bloods costed £1,646 (£41 per patient), and ASA2 costed £1,316 (£35 per patient).

Discussion: Total of £2,962 was spent on unrequired pre-operative bloods for ASA 1 and 2, mostly on CBC and U&E. This is cost effective and could’ve been invested in patient care. Most bloods were done in A&E on patient admission, potential contributing factors are unawareness and lack of trauma surgical guidelines. No limitations were noted. Future plans include spreading awareness especially in A&E, then re-audit in 1 year.