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A Mixed-Methods Study of the Variation in Routine Preoperative Clinic Utilization
Erin Kim1, Nicole M Mott2, Kristian Seiler3
1University of Michigan Medical School, Ann Arbor, Michigan.
The Journal of Surgical Research
|June 29, 2026
Summary
Preoperative clinic visits for low-risk surgery vary widely, driven mainly by surgeon preferences rather than patient risk. Standardizing these evaluations could improve healthcare value by reducing unnecessary visits.
Area of Science:
- Healthcare Management
- Surgical Optimization
- Ambulatory Surgery
Background:
- Preoperative evaluation is crucial for surgical optimization but lacks standardized protocols based on patient risk.
- Current practices for preoperative clinic utilization show significant variation, particularly for low-risk ambulatory surgery.
Purpose of the Study:
- To characterize preoperative clinic use in healthy, low-risk ambulatory surgery patients.
- To identify practice- and surgeon-level factors contributing to variation in preoperative clinic utilization.
- To find opportunities for improving quality and value in preoperative care.
Main Methods:
- Retrospective cohort study of low-risk adult patients (ASA classes I-II) undergoing low-risk ambulatory surgery (OSS 1-2).
- Analysis of preoperative clinic visits within 30 days of surgery.
- Mixed-effects logistic regression to assess surgeon and procedure variance.
- Surveys and semistructured interviews with surgeons and advanced practice providers.
Main Results:
- 52% of 3469 eligible cases had a preoperative clinic visit, with utilization varying from 22% to 88% across services.
- Surgeon (45%) and procedure type (11%) explained significant variance in clinic use.
- Clinician surveys and interviews revealed heterogeneity in perceived clinic purpose and referral criteria.
Conclusions:
- Preoperative clinic utilization for low-risk ambulatory surgery is highly variable and surgeon-dependent.
- Heterogeneity in referral practices indicates a need to align evaluations with patient risk.
- Standardizing preoperative care pathways can enhance value and potentially reduce unnecessary clinic visits.
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