Utilization of a preoperative assessment clinic in a tertiary care centre

To describe the utilization of a preoperative assessment clinic (PAC) by various surgical divisions, and the types of consultations sought by those divisions.

Cross-sectional descriptive study of PAC utilization.

A large university-affiliated tertiary care centre.

All patients who underwent surgical procedures by selected surgical divisions between July 1, 1996, and Mar. 31, 1998.

The number of patients referred to the centre's PAC, utilization by surgical division, and the types of consultation obtained (general internal medicine, anesthesia, cardiology, intensive care). Adjusted rates of consultations were determined by logistic regression, controlling for age, sex, comorbidity and major versus minor procedure.

Of 9603 surgical cases, 5725 (60%) were referred to the PAC. The adjusted rates of PAC utilization ranged from a low of 46% for cardiovascular and thoracic surgery to a high of 72% for general surgery. The adjusted rates of general internal medicine consultations ranged from 5% for oral surgery to 33% for otolaryngology. For anesthesia consultations, the rates ranged from 6% for orthopedics to 39% for general surgery. Increasing age (odds ratio [OR] = 1.14 for 10-year age increments), female sex (OR = 1.23), major surgery (OR = 1.94) and a number of comorbidity variables were significant predictors of PAC referral on multivariable analysis.

PAC utilization varies across surgical divisions and in the types of consultation sought, even when controlling for age, sex, comorbidity and type of procedure. The potential exists for standardized PAC referral guidelines to reduce these variations.