Safety and Cost-Effectiveness of Implementing Presurgical Testing Guidelines for Endometrial Cancer

The use of presurgical testing guidelines for patients with endometrial pathology undergoing hysterectomy in the ambulatory setting is safe and cost-effective, according to a study published in JCO Oncology Practice (2021;OP2100247. doi:10.1200/OP.21.00247).

A multidisciplinary team created evidence-based guidelines for presurgical testing, which were implemented on the gynecologic surgery service of a comprehensive cancer center in January 2016. This analysis aimed to evaluate the safety and cost-effectiveness of implementing these guidelines.

The analysis included all patients diagnosed with endometrial pathology who underwent ambulatory surgery between July 2014 and December 2015 (preperiod) and July 2016 and December 2017 (postperiod). A pre-post analysis was performed that compared presurgical tests and perioperative adverse events.

The direct cost of testing was used to calculate cost savings related to the reduction in presurgical testing. Cost savings were reported in percentage cost reduction.

In the preperiod, a total of 749 hysterectomies were performed. In the postperiod, 775 hysterectomies were performed. After implementation of presurgical testing guidelines, complete blood counts were reduced by 13.4%, coagulation testing was reduced by 78.1%, comprehensive metabolic panels were reduced by 36.8%, chest x-rays were reduced by 39%, and electrocardiograms were reduced by 15.5%.

In addition, rates of perioperative cardiopulmonary adverse events were similar in both time periods. No deaths were reported within 90 days of surgery.

Direct costs related to presurgical testing were reduced 41.4% in the postperiod.

“The use of evidence-based [presurgical testing] guidelines for patients with endometrial pathology undergoing hysterectomy in the ambulatory setting is safe and cost-effective. A multidisciplinary approach is essential for successful development and implementation,” concluded Emeline Aviki, MD, MBA, Memorial Sloan Kettering Cancer Center, New York, NY, and colleagues.—Janelle Bradley