Anesthesia Track: Hot-off-the-press and Abstract Session
GP4a - Is Preoperative Urine Human Chorionic Gonadotropin (hCG) Testing Necessary for Pediatric Patients before Oral and Maxillofacial Surgery Procedures?
Friday, September 16, 2022
7:30 AM – 7:40 AM CDT
Location: Great Hall A, New Orleans Ernest N. Morial Convention Center
Research Assistant Boston Children's Hospital Boston, Massachusetts
Abstract:
Purpose: Routine human Chorionic gonadrotropin (hCG) testing has been incorporated into many sedation workflows due to its sensitivity and inexpensive cost. Unrecognized pregnancies can pose possible complications to patients undergoing anesthesia however unrecognized pregnancies among adolescents are relatively rare. The purpose of this study is to evaluate the effectiveness of routine preoperative pregnancy testing in a cohort of adolescent and young adults presenting for elective outpatient oral and maxillofacial surgery procedures. Specific aims of the study include: 1.) Calculating the incidental positive pregnancy rate of preoperative hCG testing in adolescent or young adults scheduled for outpatient oral and maxillofacial surgery with intravenous (IV) sedation, 2.) Measuring the incidence that patients who are unable to provide urine sample for preoperative urine hCG testing, and 3). Quantify the costs associated with preoperative urine hCG testing.
Methods: This retrospective study assessed positive urine or serum hCG testing in post-menarchal cisgender females aged 12 to 45 years who underwent elective outpatient oral surgery procedures scheduled with intravenous sedation at Boston Children’s Hospital from July 1, 2010 to June 30, 2021. Medical records were used to identify scheduled IV sedation procedures that were canceled, rescheduled, or performed without IV sedation in the event the patient had a positive hCG test. Sub-analyses was performed for patients who were scheduled for IV sedation from June 30, 2019, through June 30, 2021, but were canceled, rescheduled, or performed without IV sedation due to inability to provide a urine sample at the time of procedure. All patients underwent urine hCG testing on the day of their scheduled procedure using the Alere hCG Cassette 20mI/mL (Alere Inc., Waltham, MA, USA). Individuals who were unable to provide urine samples on the day of their procedure had the option to reschedule the procedure, forego intravenous sedation for nitrous sedation and/or local anesthesia, or opt for a blood hCG test.
Results: This study included 5,005 patients after exclusion criteria were applied. The median (interquartile range) age at time of the procedure was 18.0 (3.6) years. A single positive urine hCG result provided an incidental preoperative pregnancy rate of 0.02% over the study period in a patient who was 25.9 years old at the time of their incidental positive test result, and reported a desire to become pregnant at the time of testing. There were 14 patients over a two year period who were unable to provide urine hCG sample that had to be rescheduled, cancelled or performed without IV sedation. The total cost of testing over the 11 year observation period was $9,019.59. The total cost of unutilized resources of staff and facilities during our 2 year sub analysis was $4,430.80 due to patients inability to provide urine hCG and procedures requiring rescheduling/cancellation.
Conclusions: Cost of delayed care and surgical cancellations due to patients’ inability to void preoperatively, call into question the necessity of preoperative hCG screening in pediatric patients presenting for elective outpatient oral and maxillofacial procedures given the lack of incidental positive pregnancies observed.
References: Konicki W, Soletic LC, Karlis V, Aaron C. Point-of-Care Pregnancy Testing in Outpatient Sedation Anesthesia: Experience from an Urban Hospital-Based Oral and Maxillofacial Surgery Clinic. J Oral Maxillofac Surg. 2021;79(12):2444-2447.
Manley S, de Kelaita G, Joseph NJ, Salem MR, Heyman HJ. Preoperative pregnancy testing in ambulatory surgery. Incidence and impact of positive results. Anesthesiology. 1995;83(4):690-693
Resnick CM, Daniels KM, Flath-Sporn SJ, Doyle M, Heald R, Padwa BL. Physician Assistants Improve Efficiency and Decrease Costs in Outpatient Oral and Maxillofacial Surgery. J Oral Maxillofac Surg Off J Am Assoc Oral Maxillofac Surg. 2016;74(11):2128-2135.