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Perioperative processes and outcomes after implementation of a hospitalist-run preoperative clinic
Sondra Vazirani1, Azadeh Lankarani-Fard, Li-Jung Liang
1Department of Medicine, Hospitalist Division, VA Greater Los Angeles Healthcare System, David Geffen School of Medicine at UCLA, Los Angeles, CA 90073, USA. Sondra.vazirani@va.gov
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.