Oral Surgery ISSN 1752-2471
LETTER TO THE EDITOR
Re: Pre-operative investigations in patients undergoing oral and
maxillofacial procedures
Dear editor,
We were most interested to note implementation of
a locally agreed surgical complexity index and junior
staff training reduced unnecessary haematological
investigations in your unit from 27.8% to 8.25%.
An audit with comparable interventions within our
unit has also yielded a reduction of unnecessary test-
ing from 76% to 25%.
In response to one of the discussion points in your
article, we identified that no unnecessary tests
ordered within our first audit cycle yielded clinically
significant abnormal results. Interestingly, however,
one patient had a post-operative haemorrhage fol-
lowing a bimaxillary osteotomy (which we also
locally classified as ‘major’ surgical complexity). A
normal baseline coagulation screen proved useful
clinical information despite not being explicitly indi-
cated within NICE guidance for a surgery of this
complexity. We note the NICE guidance on need for
coagulation screen is left ambiguous and there is no
strong evidence base to make a recommendation
either way.
Oral Surgery 11 (2018) 89.
© 2018 The British Association of Oral Surgeons and John Wiley & Sons Ltd
We would also be most interested to identify a
more objective way of stratifying surgical complexity
to strengthen the evidence behind use of the
guideline.
G. Vithlani, P. Shah, R. Patel and T. Mirza
Oral and Maxillofacial Surgery, Luton and Dunstable
University Hospital, Luton, UK
References
1. Henry A, Dewi F, Atan R, Patel N, Bhatia S. Pre-
operative investigations in patients undergoing oral
and maxillofacial procedures. Oral Surg 2016;9:155–9.
https://doi.org/10.1111/ors.12187
2. National Institute for Health and Care Excellence. Pre-
operative tests (update) Routine preoperative tests for
elective surgery. Full Guidance. April 2016. Available
from: https://www.nice.org.uk/guidance/ng45/evide
nce/full-guideline-87258149468 [accessed 30 October
2016]
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