Preanesthesia evaluation and reduction of preoperative care costs

Preanesthesia evaluation (PAE) is fundamental in the preparation of a surgical patient. Among its advantages is the reduction of preoperative care costs. Although prior studies had observed this benefit, it is not clear whether it can be taken into consideration among us. The objective of the present study was to compare the costs of preoperative care performed by the surgeon with estimated costs based on PAE. In parallel, we compared the American Society of Anesthesiologists (ASA) physical status classification determined by the anesthesiologist with that estimated by other specialists.

Two hundred patients scheduled for elective surgery or diagnostic procedures whose preoperative care was made by the surgeon underwent PAE after hospital admission. The anesthesiologist determined which ancillary exams or referrals necessary for each patient. The number and cost of ancillary exams or referrals requested by the anesthesiologist were compared with those of the preoperative preparation. The ASA classification according to the anesthesiologist was also compared to that of the physician in charge of the consultation.

Out of 1,075 ancillary exams performed, 55.8% were not indicated, which corresponded to 50.8% of the total cost of exams. The anesthesiologist considered that 37 patients (18.5%) did not require exams. The cost of surgeon-oriented preoperative care was higher than that based on the preanesthesia evaluation and this difference in costs was statistically significant (p < 0.01). In 9.3% of the patients discordance in ASA classification according to the specialist was observed.

Preoperative care based on judicious preanesthesia evaluation can result in significant reduction in costs when compared to that oriented by the surgeon. Good concordance in ASA classification was observed.