Preoperative evaluation in elective surgery. INAHTA synthesis report

Area of Science:

• Health Services Research
• Medical Policy
• Surgical Practice

Background:

• Preoperative evaluation is a critical component of elective surgery.
• Variations exist in current practices and recommendations across different regions.
• Understanding these variations is essential for improving patient care and resource management.

Purpose of the Study:

• To synthesize information from INAHTA (International Network of Agencies for Health Technology Assessment) agencies.
• To summarize indications, physician practices, and economic/legal aspects of preoperative evaluation.
• To identify areas of consensus and divergence in preoperative assessment.

Main Methods:

• Systematic review of six papers published between 1989 and 1999.
• Analysis of studies from Sweden, France, Basque Country, the Netherlands, United Kingdom, and Catalonia.
• Focus on indications, habitual attitudes, practices, and economic/legal implications.

Main Results:

• Indications for preoperative evaluation show minor variations, particularly regarding age limits.
• Significant differences observed in physician attitudes and practices compared to recommendations, especially when consensus methods were used.
• Economic benefits are substantial if recommended clinical practices are adopted; evidence-based recommendations may form a legal standard of care.

Conclusions:

• Preoperative evaluation practices are not uniformly applied, leading to potential inefficiencies and deviations from best practices.
• There is a need to align professional attitudes and customary practices with evidence-based recommendations.
• Implementing recommended practices can lead to significant cost savings and potentially establish a legal benchmark for care.