Routine Pathology Testing Prior to Bronchoscopy has Limited Clinical Impact With Significant Economic and Environmental Costs.

BACKGROUND

Routine preprocedural pathology testing is no longer recommended for minor and intermediate-risk elective procedures. British Thoracic Society guidelines advise hemoglobin, platelet count, and coagulation studies only in patients with risk factors for bleeding. Despite this, such tests are commonly ordered without a clear clinical indication before bronchoscopic procedures, incurring unnecessary financial and environmental costs.

METHODS

We conducted a retrospective review of outpatient bronchoscopic procedures over a 12-month period at an Australian tertiary hospital. Preprocedural pathology testing was defined as any test ordered at bronchoscopy referral or repeated within 6 weeks before the procedure. We evaluated the impact on clinical management and complication rate. Financial cost was estimated using Australian Medical Benefits Schedule (MBS) prices, and environmental impact via carbon dioxide equivalent (CO2e) emissions.

RESULTS

A total of 436 bronchoscopic procedures were performed, with all with preprocedural pathology testing. Abnormal results occurred in 8.3% of cases, but only 4.0% led to clinical intervention-all in patients with established risk factors. No interventions were required for patients without risk factors, and no procedures were delayed or cancelled. There was no correlation between abnormal blood test results and adverse outcomes. Routine testing cost AUD 30,441.20 (19,548.12 USD) and produced an estimated carbon footprint of 103.2 kg CO2e.

CONCLUSION

Routine pathology testing before bronchoscopic procedures offers limited value, with most results not influencing management. Clinically significant abnormalities occurred only in patients with established risk factors, supporting a targeted approach. Given the significant financial and environmental costs, transitioning to selective, evidence-based testing is essential to optimize resource use and improve sustainability.