Background: Among the various challenges facing the coagulation system, surgery seems to be one of the most important. Thus, assessing the hemorrhagic risk preoperatively is paramount. Since the development of coagulation tests (CT) in the early 90’s, considerable progress had been made in the understanding of the patient hemostatic status. Hence, medical societies issued recommendations regarding preoperative ordering of CT. This was done in an attempt to reduce inappropriate CT. However, this practice is still widespread among physicians.

Aims: Our study aimed to evaluate the knowledge, attitude, and practices of surgeons and anesthesiologists regarding preoperative hemorrhagic risk assessment.

Methods: We conducted a prospective study in a Tunisian teaching hospital: Charles Nicole.  We targeted residents and attendees in seven surgical departments and in the anesthesiology department. Data were collected via a 21-questions, self-administrated questionnaire prior to and after a training session. During this session, we have raised awareness among surgeons regarding coagulation testing’s preoperative indications and interpretation.

Results: Fifty-seven physicians were included, 33 of whom frequently ordered CT. Fifteen participants (26%) did not consider that they were ordering excessive CT. No anesthesiologist stated that they routinely ordered CT preoperatively versus 55% of surgeons (p<0.01) and no anesthesiologist was unaware of the French society of anesthesiology and reanimation recommendations versus 38% of surgeons (p<0.01). The top reason physicians said they order unnecessary CT is concern about malpractice issues. The median score for the knowledge evaluation questions was 5/8 [2.5-8] and 7/8 [4-8] after the training session.

Conclusions: Continuing medical education is an essential tool to ensure quality care and to limit resource waste in the healthcare system. Our action to streamline the prescription of CT through education seemed to be efficient. Nevertheless, it requires remote re-evaluation and long-term reinforcement.

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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/preoperative-hemorrhagic-risk-assessment-knowledge-attitude-and-practice-among-surgeons-and-anesthesiologists/