Is Veterinary Pre-anesthetic Testing Worth The Money?

Good question. While I am not a vet, I don’t think it is for the simple reason that before your pet undergoes a surgical procedure, the vet makes you sign a waiver of liability so in the off-chance that your pet does die on the operating table, they are held harmless, even if a pre-surgery blood panel was done.

My family has had a few pets. Over the past 40 years We/I have had 2 dogs spayed, 5 cats spayed, 1 dog neutered and 3 cats neutered. Aside from 3 animals, the other pets were treated at the same clinic with the same vets. The pre-surgery blood panel option never came up until I brought Jersey in for her spay three years ago. The last time I had a dog in for surgery was 9 years ago, so what changed? The management changed. My family and I have been clients at our vet clinic for over 30 years and as soon as the founding vets sold the clinic, all the fancy new procedures and options started appearing. They are still cheaper than the “city” vets and I really do like all the staff and the service they provide (the old guard are still there, just not as often), but there are just some things that just set my teeth on edge. The last thing that pissed me off was when one of the vets recommended trying out some bullshit homeopathic style “woo” on Jersey. I flat out refused because it was a course of action that I knew wouldn’t work. But hey, I would have spent $50 on a useless product and been back for another exam fee to buy the pharmaceutical drugs that eventually did work.

Here are some highlights from an actual presentation at the 2007 Pacific Vet Conference titled “Secrets of High Performing Vet Practices” The little things that made me smile;

  • Look back at your records and try to boost income during the slow months. Why do you think that pet dental health day is in February?
  • Charge more for the services rendered. A plumber or electrician charge 2 times what a vet charges for a physical exam just to show up at your door. Neither of them have 8 years of college to back them. People are more attached to their dog then their pipes in their home.
  • Reciprocation (give candy to kids and the mom will pay for that blood test)
  • Authority – Use the weight of your knowledge. Don’t let the client make choices about animal health.
  • People associate high prices with quality.
  • Check and see how much VPI (pet insurance) is willing to pay for certain procedures. Many don’t charge as much as an insurance is willing to pay them!
  • Peter Drucker said 25% of clients should be complaining about your prices.
  • Clients have no idea how much medicine should cost, so a fee increase will almost never be noticed.
  • If a client says you are expensive then tell them that quality medicine is expensive.
  • Lab work is not more than 10% of gross income. It should be more than 30%.
  • You should require all pets to have a pre-anesthetic exams.

While we’re on the topic of bill padding at the vets, I was inspired to write this article by a “sponsored post” that came up in my Facebook feed. The post was sponsored by an emergency vet clinic that, not surprisingly, received mediocre to poor ratings on the website Vet Ratingz. I do not know a single person, myself included, that has had a positive experience with an emergency clinic, so choose your clinic very carefully. Do some preemptive research so you immediately know where you want to go if an emergency does arise and try to use your regular vet if possible.

In 2007 took Jersey into an emergency clinic on a long weekend because I feared that she had bloat. $800 (All lab diagnostic work, by the way) later I was told that my dog *might* have had heat stroke and the vet had the audacity to tell me that Jersey was probably pre-diabetic. Well, it’s been almost 6 years later and still no diabeetus. I guess he attended that conference.

 

 

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8 Responses to Is Veterinary Pre-anesthetic Testing Worth The Money?

  1. SkeptVet says:

    We have to remember, of course, that money isn’t the only issue here. There is certainly controversy among veterinarians about pre-operative blood testing, not only whether to do it but when, in which patients, and which tests to run. While it is undeniable that some individuals will be saved by detecting conditions that could affect anesthetic risk if everyone is tested, it is also likely that very, very many animals will need to be tested to benefit a few. It is also possible that testing will subject some to unnecessary risks when clinically unimportant abnormalities or simple erroneous results are returned and this leads to follow-up testing or unnecessary procedures.

    Overall, I think it is not clear exactly what the perfect balance between risk and benefit is for this procedure, but here is some of the research done on the question so far.

    Is routine pre-anaesthetic haematological and biochemical screening justified in dogs? Alef, M.; Praun, F. von; Oechtering, G.
    Veterinary Anaesthesia and Analgesia 2008 Vol. 35 No. 2 pp. 132-140

    Abstract
    Objectives: To determine if routine haematological and biochemical screening is of benefit in dogs requiring anaesthesia and to establish the most useful tests for pre-anaesthetic risk assessment. Animals: One thousand five hundred and thirty-seven client-owned dogs undergoing surgery at the University of Leipzig between January 2003 and April 2004. Materials and methods: After obtaining a standardized history and a physical examination, all dogs requiring anaesthesia were assigned to an ASA physical status group, their needs for pre-anaesthetic therapy determined and an anaesthetic protocol proposed. Haematological (haematocrit, red blood cell count, white blood cell count, platelet count and haemoglobin concentration) and serum biochemistry tests (plasma urea, creatinine, glucose, total protein, sodium and potassium concentration; serum alanine aminotransferase, alkaline phosphatase and lipase activity) were then performed in all animals. The results of these were then used to: (1) re-define each dog’s ASA physical status; (2) determine any altered requirement for pre-anaesthetic therapy; (3) re-determine the suitability of the dog to undergo surgery; and (4) re-examine the suitability of the original proposed anaesthetic protocol. Results: The history and clinical examination in 1293 out of 1537 dogs (84.1%) revealed that haematological and biochemical tests would have been considered unnecessary under normal conditions. Of these, 63.9% were categorized as ASA 1, 28.5% as ASA 2, and 7.6% at higher risk. In some dogs, screening tests showed abnormal results: 16.7% of 1293 dogs had abnormal plasma urea levels, with 5.9% of values above the reference range. However, only 104 dogs (8%) would have been re-categorized at a higher physical status category had the laboratory results been available. Additional screening data indicated that surgery would have been postponed in 10 dogs (0.8%) additional pre-anaesthetic therapy would have been provided in 19 animals (1.5%) and the anaesthetic protocol altered in two dogs (0.2%). Conclusion: The changes revealed by pre-operative screening were usually of little clinical relevance and did not prompt major changes to the anaesthetic technique. Clinical relevance: In dogs, pre-anaesthetic laboratory examination is unlikely to yield additional important information if no potential problems are identified in the history and on physical examination.

    Pre-anaesthetic screening of geriatric dogs
    J S Afr Vet Assoc. March 2007;78(1):31-5.
    K E Joubert1

    Pre-anaesthetic screening has been advocated as a valuable tool for improving anaesthetic safety and determining anaesthetic risk. This study was done determine whether pre-anaesthetic screening result in cancellation of anaesthesia and the diagnosis of new clinical conditions in geriatric dogs. One hundred and one dogs older than 7 years of age provided informed owner consent were included in the study. Each dog was weighed, and its temperature, pulse and respiration recorded. An abdominal palpation, examination of the mouth, including capillary refill time and mucous membranes, auscultation, body condition and habitus was performed and assessed. A cephalic catheter was placed and blood drawn for pre-anaesthetic testing. A micro-haematocrit tube was filled and the packed cell volume determined. The blood placed was in a test tube, centrifuged and then analysed on an in-house blood analyser. Alkaline phosphatase, alanine transferase, urea, creatinine, glucose and total protein were determined. A urine sample was then obtained by cystocentesis, catheterisation or free-flow for analysis. The urine specific gravity was determined with a refractometer. A small quantity of urine was then placed on a dip stick. Any new diagnoses made during the pre-anaesthetic screening were recorded. The average age of the dogs was 10.99 +/- 2.44 years and the weight was 19.64 +/- 15.78 kg. There were 13 dogs with pre-existing medical conditions. A total of 30 new diagnoses were made on the basis of the pre-anaesthetic screening. The most common conditions were neoplasia, chronic kidney disease and Cushing’s disease. Of the 30 patients with a new diagnosis, 13 did not undergo anaesthesia as result of the new diagnosis. From this study it can be concluded that screening of geriatric patients is important and that sub-clinical disease could be present in nearly 30 % of these patients. The value of screening before anaesthesia is perhaps more questionable in terms of anaesthetic practice but it is an appropriate time to perform such an evaluation. The value of pre-anaesthetic screening in veterinary anaesthesia still needs to be evaluated in terms of appropriate outcome variables.

    - 30 new diagnoses were made based on pre-anesthetic screening
    - neoplasia (excludes cutaneous tumors), 8
    - chronic kidney disease, 6
    - Cushing’s disease, 5
    - hepatopathy, 3
    - cardiac disease, 2
    - uroliths, 1
    - chronic kidney disease and neoplasia, 1
    - osteoarthritis, 1
    - collapsed trachea, 1
    - gastric necrosis, 1
    - hypothyroid, 1
    - among the 30 patients with a new diagnosis
    - 13 did not have anesthesia as result of new diagnosis
    - 6 had further testing done to confirm diagnosis
    - 4 dogs with a pre-existing condition had another diagnosis detected

    “The effect of age and/or breed on the choice of pre-anaesthetic laboratory testing was not fully elucidated in the current study. However, preliminary results show only statistically significant differences (p < 0.05) in platelet count and ALT activity in dogs over 10 years of age. No consistent differences could be found between age groups (<2, 2–7, 7–10 and over 10 years) for the plasma concentrations of glucose, urea and lipase activity. Young dogs (<2 years) showed statistically significant but only slight differences to other age groups
    in total protein and sodium concentration.”

    “Laboratory test results were within the reference range or interpreted as being clinically irrelevant in 21 of 25 dogs experiencing complications. Relevant laboratory findings were found in only four. The incidence of
    adverse incidents was 3.8% in dogs with ‘abnormal’ laboratory results and 1.8% in animals with ‘normal’ values. Because of the limited number of complications, no statistical difference could be shown between groups.”

    As for what is done in humans, the guidelines from the American Society of Anesthesiology Task Force on Pre-anesthetic Evaluation state the following:

    ”Routine Preoperative Testing
    • Preoperative tests should not be ordered routinely.
    • Preoperative tests may be ordered, required, or performed on a selective basis for purposes of guiding or optimizing perioperative management.
    • The indications for such testing should be documented and based on information obtained from medical records, patient interview, physical examination, and type and invasiveness of the planned procedure.
    Preanesthesia Hemoglobin or Hematocrit
    • Routine hemoglobin or hematocrit is not indicated.
    • Clinical characteristics to consider as indications for hemoglobin or hematocrit include type and invasiveness of procedure, patients with liver disease, extremes of age, and history of anemia, bleeding, and other hematologic disorders.
    • Preanesthesia Serum Chemistries (i.e., Potassium, Glucose, Sodium, Renal and Liver Function Studies)
    • Clinical characteristics to consider before ordering preanesthesia serum chemistries include likely perioperative therapies, endocrine disorders, risk of renal and liver dysfunction, and use of certain medications or alternative therapies.
    • The Task Force recognizes that laboratory values may differ from normal values at extremes of age.
    • Preanesthesia Urinalysis
    • Urinalysis is not indicated except for specific procedures (e.g., prosthesis implantation, urologic procedures) or when urinary tract symptoms are present. “

    The general policy in humans is to recommend specific tests based on specific indicators of risk for each individual patient, not to routinely screen everybody who is going to undergo anesthesia. So I think a rational approach in veterinary medicine is to screen those patients which there are reasons to suspect may have relevant abnormalities, such as animals with clinical symptoms, older animals, animals with known pre-existing conditions, etc.

    • Karen Friesecke says:

      Dr. Brennan, thank-you for stopping by! I heartily agree with the notion that animals should be evaluated on a case by case basis. If my vet had a real concern ie. kidney issues for doing a test, I would absolutely do it.

    • Karen Friesecke says:

      Dr. Brennan, thank-you for stopping by! I heartily agree with the notion that animals should be evaluated on a case by case basis. If my vet had a real concern ie. kidney issues for doing a test, I would absolutely do it. And thank-you for sharing the results of those studies. I’m all about the research.

  2. Ann Paws says:

    I worked at a clinic with my favorite vet who was sincerely about saving people money. She would do all kinds of things to save people money when she could. That small clinic merged with a larger one and I went to work there too. The management at this place was HORRIBLE! I went from a place where clients loved us to a place where clients did nothing but complain it seemed. The management also sucked with their employees which is one of the reasons I was happy to leave. The vet I mentioned above was fired from this clinic… stupid them, but I figured it would happen since she didn’t like to practice by their stupid rules. The smaller clinic I first worked at made the pre-sx bloodwork optional for pets under 5 and mandatory if they were older than 5. It was only $43 anyways.
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    • Karen Friesecke says:

      Fortunately, my clinic is still good and I like the new vets a lot, it’s just the little things that bug me sometimes. Things that I/my family were never offered for the past 20 years that now seem like they are make and break things to my pets health.The past 8 the pets lived very healthy & long lives without blood work, fecal tests, heartworm tests etc. I don’t live in an area where heartworm is prevalent. NONE of my dogs have ever tested positive for heartworm and I do not know of a single person in my area that has had a heartworm positive dog. I bring my dogs in once a year for a “wellness” exam instead of the twice yearly that the clinic crawls up my ass about. Doctors recommend that humans have a yearly check-up so I’m certainly not bringing in my dogs twice a year. Like I said, it’s the little things…

      • Ann Paws says:

        Yea I feel you on all of that. I usually declined a fecal check. Heartworms are a big deal down here though. The twice a year thing is newer. I did think of another reason why pet dental month is in February, it’s the slowest month for veterinary clinics throughout the whole year. Maybe that has something to do with it.
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  3. Celly says:

    Hi Karen, I am a third year veterinary student and I think two of the reasons you are seeing all these changes is the trend in veterinary medicine and how we are taught in school, compared to many years ago. We are taught to focus on preventative medicine to catch diseases/ conditions earlier so a lot of diagnostic tests/vaccination that are not recommended prior are being offered. In addition, increasingly, clients will seek legal actions should a surgery goes wrong or a vet fails to diagnose a disease at an earlier stage, etc. So these tests are also offered (or even enforced, I imagine) to protect ourselves.

    I understand that like any other professions, it is possible to have someone who focuses too much on profits than they should. However, I would like to believe that the majority of us are in the profession to practice good medicine and put the animal health and client value as our priorities!

    • Karen Friesecke says:

      In the slim-to-none chance that a surgery goes “wrong” the owner has no legal recourse due to the fact that they signed a pre-surgical waiver. If a pet dies due to sheer vet negligence or misdiagnosis of a disease, a pet’s life in a court of law is worth maybe $1000. How much would it cost to hire a lawyer and pay for court fees? Upwards of $5,000.I don’t see many people pursuing legal action unless they have very deep pockets and an axe to grind with the vet.

      What I would like to see is some sort of regulatory body to oversee bill-padding, kickbacks, price-gouging and billing for medically unnecessary work in veterinary practice, something that is enforced in human health care.

      I’m all about providing the best care for my dogs, I’m not about paying for unnecessary medical proceedures.

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