The Effect of Outpatient Preoperative Evaluation of Hospital Inpatients on Cancellation of Surgery and Length of Hospital Stay

Klei, Wilton A. van; Moons, Karel G.M.; Rutten, C. L. G.; Schuurhuis, Anke; Knape, J. T. A.; Kalkman, Cor J.; Grobbee, Diederick E.

doi:10.1097/00000539-200203000-00030

Cited by 194 publications

(151 citation statements)

References 17 publications

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“…1 Anesthesia-run Preoperative clinics have demonstrated a reduction in surgical cancellations and length of stay (LOS). 2 Auerbach and colleagues found medical consultation to have inconsistent effects on quality of care in surgical patients, but consultations occurred, at the earliest, 1 day prior to surgery. 3 A randomized trial, performed at the Pittsburgh Veterans Administration (VA) medical center using an outpatient Internal Medicine Preoperative clinic, demonstrated a shortening of preoperative LOS but no change in total LOS, and increased use of consultants.…”

Section: Discussionmentioning

confidence: 99%

Perioperative processes and outcomes after implementation of a hospitalist‐run preoperative clinic

Vazirani

Lankarani‐Fard

Liang³

et al. 2012

Journal of Hospital Medicine

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BACKGROUND:A structured, medical preoperative evaluation may positively impact the perioperative course of medically complex patients. Hospitalists are in a unique position to assist in preoperative evaluations, given their expertise with inpatient medicine and postoperative surgical consultation.OBJECTIVE:To evaluate specific outcomes after addition of a Hospitalist‐run, medical Preoperative clinic to the standard Anesthesia preoperative evaluation.DESIGN, SETTING, PATIENTS:A pre/post retrospective, comparative review of outcomes of 5223 noncardiac surgical patients at a tertiary care Veterans Administration (VA) medical center.RESULTS:Length of stay was reduced for inpatients with an American Society of Anesthesia (ASA) score of 3 or higher (P < 0.0001). There was a trend towards a reduction in same‐day, medically avoidable surgical cancellations (8.5% vs 4.9%, P = 0.065). More perioperative beta blockers were used (P < 0.0001) and more stress tests were ordered (P = 0.012). Inpatient mortality rates were reduced (1.27% vs 0.36%, P = 0.0158).CONCLUSION:A structured medical preoperative evaluation may benefit medically complex patients and improve perioperative processes and outcomes. Journal of Hospital Medicine 2012. © 2012 Society of Hospital Medicine

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Section: Discussionmentioning

confidence: 99%

Perioperative processes and outcomes after implementation of a hospitalist‐run preoperative clinic

Vazirani

Lankarani‐Fard

Liang³

et al. 2012

Journal of Hospital Medicine

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“…Consequently, many patients are not evaluated by an attending anesthesiologist at all prior to surgery. It has been estimated that greater than 50% of patients do not visit a preadmission testing center, even though these have been showed to be efficient and costeffective [1][2][3][4][5][6][7][8][9]. Preoperative testing for surgery is estimated to account for approximately $30 billion in health care costs annually in the US and a majority of these tests may be unnecessary [10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Reference Guidelines Improve Residents? Ability to Order Appropriate Preoperative Tests in Standardized Case Scenarios

Katz¹

2013

J Anesth Clin Res

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Background: Preoperative testing for surgery is estimated to cost $30 billion annually. The goal of this study was to determine the relative influence of access to a guideline reference for preoperative test ordering appropriateness by resident physicians in simulated case scenarios.Methods: At a single teaching hospital, 80 PGY (Post Medical School Graduation Year) 2-5 residents from anesthesiology, surgery, internal medicine, and obstetrics/gynecology were recruited to review simulated case scenarios. Participants within each specialty were randomized with half receiving supplemental ASA preoperative testing guidelines during completion of the questionnaire. Participants indicated which preoperative tests they believed appropriate for each scenario. Correct responses were set by an expert panel and results were reported as relative probabilities and 95% CI.Results: 66 surveys were analyzed. In the entire cohort, the group receiving supplemental guidelines achieved a greater percentage of correct answers (x=84.2%) compared to the group without guidelines (x=78.6%) (relprob =1.07 [CI 1.01-1.12], p=0.011). Correct answers improved to 1.07 [1.01-1.12] with a guideline across specialties and experience levels. Without a guideline, correct answer rates were greater for anesthesia vs surgery residents (1.19 [1.08, 1.31]) and anesthesia vs internal medicine residents (1.16 [1.04, 1.31]). With guidelines, these differences were maintained. Without a guideline, significant differences were noted between PGY 3 vs PGY 2 residents (1.12 [1.03, 1.23]) and PGY 4 vs PGY 2 residents (1.11 [1.03, 1.20]), but these differences were not present with guidelines. Surgery residents did not improve with the guideline. Conclusions:In a set of simulated clinical scenarios, reference to ASA-adapted guidelines improved test ordering by the majority of resident physicians. While anesthesia residents performed better than others independent of the guideline, the guideline negated the effect of experience in non-anesthesia trainees. Given the financial burden of inappropriate preoperative test ordering, further validation of the benefits of guideline implementation is warranted.

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“…Realizava-se uma "bateria" de exames complementares para praticamente todos os pacientes a serem submetidos a procedimentos ciExames Complementares Pré-Operatórios: Análise Crítica* [11][12][13][14][15][16][17][18][19][20] . Após a definição de padrões mí-nimos de exames laboratoriais, obteve-se redução dos gastos hospitalares, sem prejuízo na qualidade da avaliação pré-operatória dos pacientes [21][22][23][24][25][26][27][28][29][30][31] . 34 publicaram revisão sistemática sobre o valor da realização de radiografia no período pré-operatório com finalidade diagnóstica, encontrando 14 publicações que satisfaziam os critérios de inclusão, apenas estudos não-controlados e não-aleatórios.…”

Section: Introductionunclassified

“…When one takes into account the patient's history and physical exam, 60% to 70% of laboratory exams are not really necessary [11][12][13][14][15][16][17][18][19][20] . After defining the minimal standards for laboratory exams, there was a reduction in hospital costs without decreasing the quality of preoperative evaluation [21][22][23][24][25][26][27][28][29][30][31] . …”

Section: Introductionmentioning

confidence: 99%

Exames complementares pré-operatórios: análise crítica

Mathias¹,

Guaratini²,

Gozzani³

et al. 2006

Rev. Bras. Anestesiol.

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The Effect of Outpatient Preoperative Evaluation of Hospital Inpatients on Cancellation of Surgery and Length of Hospital Stay

Abstract: An observational study was conducted to compare various outcomes before and after the introduction of outpatient preoperative evaluation (OPE). Although smaller than anticipated, OPE for potential inpatients leads to a significant reduction of canceled cases and of length of admission.

Cited by 194 publications

References 17 publications

Perioperative processes and outcomes after implementation of a hospitalist‐run preoperative clinic

Perioperative processes and outcomes after implementation of a hospitalist‐run preoperative clinic

Reference Guidelines Improve Residents? Ability to Order Appropriate Preoperative Tests in Standardized Case Scenarios

Exames complementares pré-operatórios: análise crítica

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