Abstract
Purpose
This study was designed to assess the effect of preoperative medical consults on both perioperative management and surgical outcome.
Methods
The charts of 387 consecutive patients over the age of 50 undergoing non-cardiac, elective surgery during a six-week period were retrospectively examined. Patient factors including age, ASA status, gender, type of surgery, outcome (death, unexpected intensive care unit admission or uncomplicated discharge), presence of medical consult, and, in those cases where a medical consult was present, stated reason for the consult, the ordering physician, and recommendations of the consultant, were recorded.
Results
138 patients receiving medical consults (35.7%) were identified (a total of 146 consults). The most common stated purpose of the consults examined was “preoperative evaluation.” In only five consults (3.4%) did the consultant identify a new finding. Sixty-two consults (42.5%) contained no recommendations. There was no statistically significant difference in outcome between those patients who received a medical consult and those who did not.
Conclusion
A review of 146 medical consults suggests that the majority of such consults give little advice that truly impacts either perioperative management or outcome of surgery.
Résumé
Objectif
Évaluer ľeffet des consultations médicales préopératoires sur la prise en charge périopératoire et les suites opératoires.
Méthode
Nous avons procédé à ľexamen rétrospectif des dossiers de 387 patients consécutifs de plus de 50 ans qui, au cours de six semaines, ont été admis pour une intervention chirurgicale réglée non cardiaque. Nous avons noté ľâge, ľétat physique ASA, le type ďintervention chirurgicale, les suites (décès, admission imprévue à ľunité des soins intensifs ou absence de complications), la présence de con sultation médicale et la raison de la consultation, le médecin référant et les recommandations du consultant.
Résultats
Nous avons trouvé 138 patients (35,7 %) vus en consultation médicale pour un total de 146 consultations. Le motif de consultation le plus courant était «ľévaluation préopératoire». Dans cinq cas seulement (3,4 %) le consultant a découvert un nouveau problème. Soixante-deux consultations (42,5 %) ne contenaient aucune recommandation. Les suites opératoires n’étaient pas statistiquement différentes entre les patients vus ou non en consultation médicale.
Conclusion
Une revue de 146 consultations médicales montre que la majorité donne peu ďavis à incidence véritable sur la prise en charge périopératoire ou sur les suites postopératoires.
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Katz, R.I., Cimino, L. & Vitkun, S.A. Preoperative medical consultations: impact on perioperative management and surgical outcome. Can J Anesth 52, 697–702 (2005). https://doi.org/10.1007/BF03016556
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DOI: https://doi.org/10.1007/BF03016556