NEW YORK—June 13, 2008
“There are no standard recommendations and it is my sense that most places do not have a protocol like this in effect,” said Richard L. Kahn, M.D., attending anesthesiologist at Hospital for Special Surgery and lead author of the study. “But the majority of the surgeries HSS performs are elective. By testing all women of child-bearing age on the same day of their surgery we can make sure that the patient has all the facts to make the best informed decision.”
The doctors found of 2,588 women tested, five patients had a positive pregnancy test. All of the patients postponed surgery and only one was a false positive.
The American Society of Anesthesiologists gives individual hospitals and physicians the opportunity to define and institute their own policies in regards to pre-operation pregnancy testing. Like many hospitals, Hospital for Special Surgery had been conducting some tests a week before the scheduled surgery, but it wasn’t a consistent protocol.
“Pregnancy hormone levels can change within the week leading up to surgery, and HSS was concerned that it was missing some pregnancies,” said Dr. Kahn. “We instituted the new policy in November 2004 and the study looked at the cost-benefit ratio within the first full year, January 2005 – January 2006, which the protocol was in effect.”
While there is no conclusive evidence, there are associated pregnancy risks with any surgery. Both the stress the mother is under during surgery or the anesthesia could contribute to a spontaneous miscarriage or to an increased chance of birth defects. Doctors at Hospital for Special Surgery always explain the risks to patients who are pregnant, but if the patient herself doesn’t know she is pregnant she may not spend much time weighing the risks.
The direct cost associated with each urine pregnancy test is $5.03. Therefore, it cost HSS $3,273 in lab and labor costs to detect each unrecognized pregnancy, though this does not include the indirect costs associated with a cancelled surgery. However, if a woman who didn’t know she was pregnant went on to either lose the pregnancy or have a child with a birth defect, the unknown role that anesthesia and surgery may have played in this can be devastating to patient and physician. The benefit of eliminating this possibility, Dr. Kahn said, is more than enough to justify the cost of testing and inconvenience of a postponed surgery.
“Based on the outcome of this study, the same-day pregnancy testing is still in effect at HSS,” said Dr. Kahn. “If I were to move to another hospital that did not perform same-day pregnancy testing, I would work to institute a similar policy. What it comes down to is providing the best care for our patients, and I believe this protocol allows us to do that.”
About HSS | Hospital for Special Surgery
HSS is the world’s leading academic medical center focused on musculoskeletal health. At its core is Hospital for Special Surgery, nationally ranked No. 1 in orthopedics (for the eighth consecutive year) and No. 3 in rheumatology by U.S. News & World Report (2017-2018). Founded in 1863, the Hospital has one of the lowest infection rates in the country and was the first in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center four consecutive times. The global standard total knee replacement was developed at HSS in 1969. An affiliate of Weill Cornell Medical College, HSS has a main campus in New York City and facilities in New Jersey, Connecticut and in the Long Island and Westchester County regions of New York State. In 2017 HSS provided care to 135,000 patients and performed more than 32,000 surgical procedures. People from all 50 U.S. states and 80 countries travelled to receive care at HSS. In addition to patient care, HSS leads the field in research, innovation and education. The HSS Research Institute comprises 20 laboratories and 300 staff members focused on leading the advancement of musculoskeletal health through prevention of degeneration, tissue repair and tissue regeneration. The HSS Global Innovation Institute was formed in 2016 to realize the potential of new drugs, therapeutics and devices. The culture of innovation is accelerating at HSS as 130 new idea submissions were made to the Global Innovation Institute in 2017 (almost 3x the submissions in 2015). The HSS Education Institute is the world’s leading provider of education on the topic on musculoskeletal health, with its online learning platform offering more than 600 courses to more than 21,000 medical professional members worldwide. Through HSS Global Ventures, the institution is collaborating with medical centers and other organizations to advance the quality and value of musculoskeletal care and to make world-class HSS care more widely accessible nationally and internationally.