TY - JOUR
T1 - Use of preoperative haemostasis and ABO blood typing tests in children
T2 - A retrospective observational study using a nationwide claims database in Japan
AU - Yonekura, Hiroshi
AU - Ide, Kazuki
AU - Kanazawa, Yuji
AU - Takeda, Chikashi
AU - Nakamori, Yuki
AU - Matsunari, Yasunori
AU - Sakai, Michihiro
AU - Kawakami, Koji
AU - Kamei, Masataka
N1 - Funding Information:
Preoperative haemostasis and ABO blood typing tests were performed in a majority of children before undergoing common paediatric surgeries despite the low postoperative transfusion and reoperation events. Preoperative tests were associated with the anaesthesia, surgical type and surgical setting. We thank the staff at JMDC, Tokyo, Japan, for their assistance with data preparation. We also thank our colleagues from the Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University for their assistance with data preparation. The authors also thank Editage ( http://www.editage.jp ) for English language editing. Contributors HY conceived the study, collected, analysed, interpreted the data and results, and drafted the manuscript. KI analysed the data and performed statistical analyses. HY, KI, YK, CT, YN, YM, MS, KK and MK conceived the study and interpreted the data and drafted the manuscript. All authors critically revised the manuscript for intellectual content. All authors read and approved the final manuscript. Funding This work was supported in part by grants from the Pfizer Health Research Foundation and the Japanese Society of Anesthesiologists. Competing interests KK received honoraria from Shin Nippon Biomedical Laboratories; research funds from Bayer Yakuhin, CMIC, Novartis Pharma K.K., Suntory Beverage & Food, Dainippon Sumitomo Pharma and Stella Pharma; and holds stocks in School Health Record Center and Real World Data. There are no patent products under development or marketed products to declare, relevant to those companies. Patient consent for publication Not required. Ethics approval This study was by the Ethics Committee of Mie University Graduate School and Faculty of Medicine (approval number: H2018-094), who waived the requirement for obtaining informed consent from the patients due to the anonymous nature of the data. Provenance and peer review Not commissioned; externally peer reviewed. Data availability statement Data are available on reasonable request. Author note This retrospective observational study was conducted according to the 'Strengthening the Reporting of Obervational studies in Epidemiology' (STROBE) guidelines.
Publisher Copyright:
© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2019/11/1
Y1 - 2019/11/1
N2 - Objectives To describe the prevalence and factors associated with preoperative haemostasis and ABO blood typing tests for children because these tests might represent low-value care. Design A retrospective observational study. Setting Nationwide insurance claims database in Japan. Participants Patients aged 1-17 years who underwent common non-cardiac surgeries between April 2012 and March 2018 were included. Patients with high-risk comorbidities for bleeding (n=175) and those with multiple eligible surgeries were excluded (n=2121). Main outcome measures We described the proportions of each preoperative test performed within 60 days before an index surgery, including platelet count, prothrombin time (PT), activated partial thromboplastin time (aPTT) and ABO blood typing tests. We also explored the associations between patient-level and institutional-level factors and any preoperative tests, using multilevel logistic regression analysis. Results We included 13 018 patients (median (IQR) age, 5.2 (2.9-7.7) years; 8276 (63.6%) boys) from 1499 institutions. The overall proportion of each test was as follows: platelet count, 78.6%; PT, 54.4%; aPTT, 56.4% and ABO blood typing tests, 50.4%. The proportion of patients undergoing any preoperative tests in the overall sample was 79.3%. Multilevel logistic regression analysis indicated that preoperative tests were associated with type of anaesthesia (general anaesthesia: adjusted OR 7.06; 95% CI 4.94 to 10.11), type of surgery (tonsillectomy: adjusted OR 3.45; 95% CI 2.75 to 4.33) and surgical setting (inpatient procedure: adjusted OR 5.41; 95% CI 3.83 to 7.66). There was one postoperative transfusion event (0.008%) in the entire cohort and 37 postoperative reoperation events for surgical bleeding after tonsillectomy (0.90%). Conclusions In the largest Japanese cohort reported to date, preoperative haemostasis and ABO blood typing tests were performed in a majority of children prior to common paediatric surgeries. Preoperative tests were associated with anaesthesia, surgical type and surgical setting.
AB - Objectives To describe the prevalence and factors associated with preoperative haemostasis and ABO blood typing tests for children because these tests might represent low-value care. Design A retrospective observational study. Setting Nationwide insurance claims database in Japan. Participants Patients aged 1-17 years who underwent common non-cardiac surgeries between April 2012 and March 2018 were included. Patients with high-risk comorbidities for bleeding (n=175) and those with multiple eligible surgeries were excluded (n=2121). Main outcome measures We described the proportions of each preoperative test performed within 60 days before an index surgery, including platelet count, prothrombin time (PT), activated partial thromboplastin time (aPTT) and ABO blood typing tests. We also explored the associations between patient-level and institutional-level factors and any preoperative tests, using multilevel logistic regression analysis. Results We included 13 018 patients (median (IQR) age, 5.2 (2.9-7.7) years; 8276 (63.6%) boys) from 1499 institutions. The overall proportion of each test was as follows: platelet count, 78.6%; PT, 54.4%; aPTT, 56.4% and ABO blood typing tests, 50.4%. The proportion of patients undergoing any preoperative tests in the overall sample was 79.3%. Multilevel logistic regression analysis indicated that preoperative tests were associated with type of anaesthesia (general anaesthesia: adjusted OR 7.06; 95% CI 4.94 to 10.11), type of surgery (tonsillectomy: adjusted OR 3.45; 95% CI 2.75 to 4.33) and surgical setting (inpatient procedure: adjusted OR 5.41; 95% CI 3.83 to 7.66). There was one postoperative transfusion event (0.008%) in the entire cohort and 37 postoperative reoperation events for surgical bleeding after tonsillectomy (0.90%). Conclusions In the largest Japanese cohort reported to date, preoperative haemostasis and ABO blood typing tests were performed in a majority of children prior to common paediatric surgeries. Preoperative tests were associated with anaesthesia, surgical type and surgical setting.
UR - http://www.scopus.com/inward/record.url?scp=85075798888&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85075798888&partnerID=8YFLogxK
U2 - 10.1136/bmjopen-2019-032306
DO - 10.1136/bmjopen-2019-032306
M3 - Article
C2 - 31780592
AN - SCOPUS:85075798888
VL - 9
JO - BMJ Open
JF - BMJ Open
SN - 2044-6055
IS - 11
M1 - e032306
ER -