Investigation Profiles and Costs of Preoperative Evaluation among Vascular Surgery Patients at a Tertiary Hospital in Addis Ababa, Ethiopia

Abstract

Background Preoperative evaluation is essential for ensuring patient safety prior to vascular surgery. However, overutilization of routine tests without clinical indication can impose significant financial burden on people, especially those who are living in resource-limited settings. This study aim was to assess preoperative evaluation in vascular patients with its associated direct patient cost and cost drivers in Tikur Anbessa Specialized Hospital (TASH). Objective To assess the direct cost, and key cost drivers of preoperative investigations among patients who underwent elective vascular surgery at Tikur Anbessa Specialized Hospital (TASH) from Jan2022 to December 2024. Methods An institutional-based retrospective cross-sectional study was conducted for vascular patients operated from January 2022 to December 2024 at TASH, assessing costs associated with preoperative investigations. Data were collected from medical records and finance logs. Investigations were categorized as indicated or unnecessary based on National Institute for Health and Care Excellence (NICE) guidelines 2016. Costs were determined using TASH service fees and private center rates and patients information. Data were analyzed using SPSS version 21. Results A total of 165 elective vascular surgery patients were randomly selected; the mean age of participants was 49.6 years, with 53.3% male and 46.7% female. Peripheral artery disease was the most common diagnosis (47.3%). The average hospital stay was 13.7 days. The mean total cost of preoperative investigations per patient was 9,717.40 Ethiopian Birrs (ETB), with imaging averaging 8,797 ETB and laboratory tests averaging 1,328 ETB. HIV screening was not commonly provided for elective vascular patients. Linear Regression was conducted to explore relationships between patient demographics, clinical factors, and both the number and cost of investigations. Age, ASA class, comorbidity and longer hospital days were positively associated with increased total cost. Conclusion Preoperative evaluation in vascular surgery at TASH is characterized by excessive use of routine and advanced investigations, some of which lack clinical indication. These practices contribute to substantial patient expenses, primarily through out of pocket payments. There is also gap in providing some investigation tests like serum albumin and calcium. Developing and implementing evidence based testing guidelines could limit the cost.

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