Preanesthesia evaluation for ambulatory surgery

Hofer, Jennifer; Chung, Esther; Sweitzer, Bobbie Jean

doi:10.1097/aco.0000000000000006

Cited by 14 publications

(5 citation statements)

References 20 publications

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“…9 In this context, preoperative assessment clinics are being increasingly used for patients who will undergo minor surgery, often to the detriment of candidates for major surgery. 10,11 Among cataract surgery candidates, for instance, despite the low incidence of perioperative morbidity and mortality 12,13 and because lack of recommendation for routine medical testing before surgery, 14 these patients have been seen more frequently in preoperative consultations, and the referrals do not seem to be based on medical factors, but geographic variation. 15 Since 2006, operates at our institution the preoperative clinic attended by anesthesiologists and referral may be performed as deemed necessary by the surgeon.…”

Section: Introductionmentioning

confidence: 99%

The impact of preoperative evaluation on perioperative events in patients undergoing cataract surgery: a cohort study

Alboim

Kliemann

Soares

et al. 2016

Eye

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Purpose Ambulatory surgery is a major area of surgical and anesthetic practice, and preoperative clinics are being increasingly used for low-risk surgical procedures. This study investigated the impact of preoperative evaluation on perioperative events in patients undergoing cataract surgery. Methods This was a retrospective cohort study of 968 consecutive patients undergoing cataract surgery. Details of medical conditions, surgical, anesthetic, and postoperative information were collected from medical records. A logistic regression model was developed using propensity score adjustment for baseline characteristics. Results Out 968 patients included, 240 (24.7%) underwent outpatient preoperative evaluation. There were no perioperative major cardiovascular events. Hypertension occurred in 319 (33%) patients, accounting for 79.7% of all adverse events. Preoperative evaluation resulted in a lower hypertension rate after adjustment for propensity score (OR = 0.6; 95% CI 0.41-0.93); no effects were observed on posterior capsule rupture and emergency visits/hospitalization within 7 days of surgery. Eighty-nine patients (9.3%) had an initial systolic pressure ≥ 180 mm Hg, which was not associated with higher risk of posterior capsule rupture (P = 0.158) or postoperative adverse events (P = 0.902). Median waiting time to surgery was 6 and 2 months for evaluated and non-evaluated patients, respectively (Po0.001). Conclusions In the context of low-risk surgery and no major perioperative and postoperative outcomes, it appears that outpatient preoperative evaluation has no role in reducing adverse events in cataract surgery candidates. Despite fewer hypertensive episodes observed in evaluated patients, these episodes were not associated with any medical or surgical outcomes.

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Section: Introductionmentioning

confidence: 99%

The impact of preoperative evaluation on perioperative events in patients undergoing cataract surgery: a cohort study

Alboim

Kliemann

Soares

et al. 2016

Eye

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“…No presente estudo, avaliamos pacientes que realizaram cirurgias dermatológicas ambulatoriais (baixo risco cirúrgico) e que fizeram uma avaliação pré-operatória somente com o cirurgião ou com o cardiologista também. Apesar de serem conceituados como procedimentos de baixa complexidade, ainda são solicitados vários exames e avaliações pré-operatórias cardiovasculares e são poucos os estudos sobre o efeito do pré-operatório de cirurgias dermatológicas e as implicações em seus desfechos, por isso tal procedimento foi escolhido para análise em nosso trabalho 11 .…”

Section: Discussionunclassified

Avaliação pré-operatória na cirurgia ambulatorial dermatológica de baixa complexidade

Etcheverria,

Moretti,

Batista

et al. 2023

Rev. Med. (São Paulo)

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Introdução: A avaliação pré-operatória fornece dados sobre o paciente, que irão auxiliar no preparo da cirurgia. Nas cirurgias ambulatoriais, de baixa complexidade, os critérios para a realização dessa avaliação não são bem definidos nas diretrizes. Objetivo: comparar estratégias de avaliação e seu impacto na evolução perioperatória. Método: Estudo prospectivo e controlado em cirurgia dermatológica. Incluídos pacientes de baixo e moderado risco pelo score EMAPO (Estudo multicêntrico de avaliação perioperatória para operações não cardíacas). Divididos em dois grupos: (G1) avaliação com o cirurgião; (G2) avaliação com cirurgião e com cardiologista. Seguimento de sete dias. Analisados dados sobre o procedimento, evolução e eventos adversos. Avaliação estatística: Shapiro-Wilk. Teste χ2 de Pearson e test T ou Mann-Whitney (IC 95% com P<0.05). Resultados: 299 pacientes avaliados (G1=200 e G2=99). Todos liberados para cirurgia, sem nenhuma orientação especial. Grupos homogêneos, EMAPO (G1=2.6 ± 3.6 e G2=2.7 ± 3.2), exceto pela dislipidemia (G1=13,5% e G2=23,2% p=0,03). Não houve eventos cardiovasculares. Três pacientes do G2 e um no G1 tiveram infecção de ferida operatória. Os pacientes do G2 realizaram mais exames (5.1 ± 1.7 vs 1.3 ± 1.7; p<0.01). O tempo de espera para a realização da cirurgia foi menor no G1 (2.7 ± 2.1 meses) em relação a G2 (6.8 ± 4.6m) (p<0.01). Conclusão: Não há necessidade de avaliação pré-operatória com cardiologista e/ou mais exames em pacientes de baixo ou médio risco pelo score EMAPO para cirurgias dermatológicas ambulatoriais.

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“…Preoperative assessments serve medical optimization of the patients preoperatively for decreasing morbidity and improving outcomes. For this reason, the preoperative visit must be patient-directed, targeted interventions rather than protocolized routine preoperative preparations [7]. In 2009, a report from the Centers for Disease Control and Prevention claimed that more than 34 million ambulatory surgical visits were performed in the United States annually, and the reported safety profile of outpatient surgery has historically been excellent [8].…”

Section: Discussionmentioning

confidence: 99%

Risk Assessment in Surgical Patients: American Society of Anesthesiologist’s (ASA) Classification vs Intraoperative Therapeutic and Diagnostic Interventions (I-ITS)

Çevik¹,

Yüce²

2018

AJCMR

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Background: In this prospective study of 859 surgical patients in a tertiary research hospital, we examined the association between ASA physical status classification and Intraoperative Therapeutic Intervention Score (I-TIS). Methodology: All patients were assigned by ASA classification before the operation and received a value of 1-4 points for I-TIS score during surgical procedures. Surgical complexity was also classified and correlation with I-TIS was examined. Results: The correlation coefficient of the ASA with I-TIS was r=0.55 (p<0.01). The correlation between the surgical complexity was r=0.66 (p<0.001). Five patients (ASA IV) with I-TIS score>25 and surgical complexity of major plus were admitted to the intensive care unit. Two of them were followed up six hours and the other three stayed more than 24 hours in the intensive care unit. Conclusions: It's concluded that I-TIS score may be validated for our surgical patients but this assessment may show variability among institutions. The ASA classification is the most valued and widely used scoring system for evaluation of perioperative risk in surgical patients. It is simple, easy and also a useful tool to assist descriptions of workload and 'anesthetic risk' for analysis and research purposes.

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Preanesthesia evaluation for ambulatory surgery

Cited by 14 publications

References 20 publications

The impact of preoperative evaluation on perioperative events in patients undergoing cataract surgery: a cohort study

The impact of preoperative evaluation on perioperative events in patients undergoing cataract surgery: a cohort study

Avaliação pré-operatória na cirurgia ambulatorial dermatológica de baixa complexidade

Risk Assessment in Surgical Patients: American Society of Anesthesiologist’s (ASA) Classification vs Intraoperative Therapeutic and Diagnostic Interventions (I-ITS)

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