Information technology-based joint preoperative assessment, risk stratification and its impact on patient management, perioperative outcome, and cost

Abstract

Background: Despite negative recommendations, routine preoperative testing practice is nearly universal. Our aim is to bring the healthcare providers on one platform by using information-technology based preanaesthetic assessment and evaluate the routine preoperative testing’s impact on patient outcome and cost. Methods: A prospective, non-randomised study was conducted in a teaching hospital during January 2019-August 2020. A locally developed software and cloud-computing were used as a tool to modify preanaesthesia evaluation. The number of investigations ordered, time taken, cost incurred, were compared with the routine practice. Further data were matched as per surgical invasiveness and the patient's physical status. Appropriate tests compared intergroup differences and p-value <0.05 was considered significant. Results: Data from 114 patients (58 in routine and 56 in patient and surgery specific) were analysed. Patient and surgery specific investigation led to a reduction in the investigations by 80-90%, hospital visit by 50%, and the total cost by 80%, without increasing the day of surgery cancellation or complications. Conclusion: Information technology-based joint preoperative assessment and risk stratification are feasible through locally developed software with minimal cost. It helps in applying patient and surgery specific investigation, reducing the number of tests, hospital visit, and cost, without adversely affecting the perioperative outcome. The application of the modified method will help in cost-effective, yet quality and safe perioperative healthcare delivery. It will also benefit the public from both service and economic perspective.

Epidemiology of primary and revision total knee arthroplasty: analysis of demographics, comorbidities and outcomes from the national inpatient sample

“…The projected increase in rTKA is expected to pose a heavy financial burden on the healthcare system [ 6 ]. Improved perioperative optimization of medical and social comorbidities has been shown to improve outcomes and decrease failure of TKA, potentially serving as an opportunity to decrease the revision burden and lead to health care savings [ 11 ]. While perioperative optimization has been an apparent effort in TKA, similar efforts should be made on rTKA recipients given the complexity and risk associated with the procedure.…”

Effectiveness of pre-anaesthetic assessment clinic: a systematic review of randomised and non-randomised prospective controlled studies

“…Healthcare professionals and policymakers are exploring strategies to reduce unnecessary investigations without compromising quality of care and patient safety. 39 Transition of evidence-based interventions to the hospital systems can provide substantial benefits to patient care. 40 According to the ASA and the National Institute of Health and Care Excellence, routine preoperative laboratory tests are not recommended for relatively healthy patients.…”

Educating Family Physician Residents for Anesthetic Preoperative Evaluation and Clearance

“…Despite this, routine testing is still used widely during preoperative evaluations due to the efficiency and availability of modern laboratory testing. 6 Although it may be tempting to utilize available resources, Karim et al 7 indicated that specific preoperative testing reduced patients’ costs by 80–90%, while also reducing hospital visits by 50% compared to patients that were pre-evaluated using routine testing. Therefore, it is imperative that family medicine residents learn the components necessary for an adequate preoperative assessment during the post-graduate phase of their training.…”