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Computational and Mathematical Methods in Medicine
Volume 2017 (2017), Article ID 3624075, 6 pages
https://doi.org/10.1155/2017/3624075
Research Article

Influence of Institution-Based Factors on Preoperative Blood Testing Prior to Low-Risk Surgery: A Bayesian Generalized Linear Mixed Approach

1Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshida-konoecho, Sakyo-ku, Kyoto 606-8501, Japan
2Center for the Promotion of Interdisciplinary Education and Research, Kyoto University, Yoshida-honmachi, Sakyo-ku, Kyoto 606-8501, Japan
3Clinical Research Center, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba 260-8677, Japan

Correspondence should be addressed to Koji Kawakami; pj.ca.u-otoyk@e4.ijok.imakawak

Received 23 March 2017; Revised 7 October 2017; Accepted 13 November 2017; Published 7 December 2017

Academic Editor: Chuangyin Dang

Copyright © 2017 Kazuki Ide et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

To optimize delivery of health care services in clinical practice, the use of unnecessary interventions should be reduced. Although recommendations for this reduction have been accepted worldwide, recent studies have revealed that the use of such procedures continues to increase. We conducted a retrospective cohort study using a nationwide claim-based database to evaluate factors influencing preoperative blood testing prior to low-risk surgery, via a Bayesian generalized linear mixed approach. The study period was set from April 1, 2012, to March 31, 2016, and 69,252 surgeries performed at 9,922 institutions were included in the analysis. Mean patient age was 44.3 ± 11.3 years (57% female). Preoperative blood tests were performed for 59.0% of procedures. Among institutional factors, the number of beds was strongly associated with preoperative blood testing (odds ratio [95% highest posterior density interval (HPD interval)], 2.64 [2.53 to 2.75]). The difference (95% credible interval) in the rate of preoperative blood testing between institutions with <100 beds and ≥100 beds was 0.315 [0.309 to 0.322], and the Bayesian index was 1.00. This indicated that preoperative blood tests are strongly influenced by institutional factors, suggesting that specific guidelines should be developed to avoid excessive preoperative testing for low-risk surgery.