Surgeons' views on preoperative medical evaluation: a qualitative study

Area of Science:

• Medical practice
• Surgical outcomes
• Healthcare systems

Background:

• Preoperative medical evaluation (PME) practices vary widely, with limited evidence of benefit, raising concerns about overuse.
• Surgeons play a critical role in the multidisciplinary PME process.
• This study explores surgeons' perspectives on PME.

Purpose of the Study:

• To investigate surgeons' current practices and beliefs regarding preoperative medical evaluation (PME).
• To understand surgeons' perceptions of PME benefits, harms, and impact on surgical decision-making.
• To identify barriers and facilitators for potential improvements in PME.

Main Methods:

• Qualitative study involving semi-structured interviews with 18 surgeons in Baltimore, Maryland.
• Purposive sampling ensured diversity in practice type, specialty, gender, and experience.
• Content analysis of interview transcripts identified key themes regarding PME practices and beliefs.

Main Results:

• Significant variation exists in surgeons' PME practices and beliefs.
• Surgeons perceive PME as beneficial for outcomes but acknowledge it doesn't benefit all patients.
• Hospital and anesthesiology requirements, rather than clinical evidence, largely drive PME; surgeons feel confident in their own risk assessment and seek standardization.

Conclusions:

• Surgeons' views are crucial for future research and reforms in preoperative medical evaluation.
• Standardization of PME is welcomed by surgeons.
• Current practices are maintained due to perceived malpractice protection and inadequate evidence for change.