To the Editor.—
I enjoyed reading "The Usefulness of Preoperative Laboratory Screening."1 However, the authors fail to address the usefulness of one of their standard laboratory tests—the rapid plasma reagent (RPR) test. Since their medical center has approximately 8,600 elective surgical admissions per year and each includes an RPR, this cost (at $13.50 per test) is $116,100 annually.The value of routine serological tests either as an admission requirement to hospitals2,3 or for premarital examination by law4 has been debated. Its value in preventing congenital syphilis is not in question. San Francisco does have the highest civilian reported rate of primary and secondary syphilis in the United States.5 However, what percentage is from hospital screening vs venereal disease clinics, blood bank screening, or premarital screening is unknown to me.Except for a positive serological test result being a relative contraindication to spinal anesthesia, it is unlikely that
Boren SD. The Usefulness of the RPR. JAMA. 1985;254(24):3421. doi:10.1001/jama.1985.03360240033010
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