[15 years of preoperative ambulatory care in Graz]

In 1977 a new anaesthesiology preoperative evaluation clinic was started for evaluation of all elective surgical patients for their fitness to undergo anaesthesia. Physical examination, medical history and anaesthetic risk assessment are assessed in a standardized manner with the aid of computer menus. Comprehensive laboratory tests included electrocardiography, lung function assessment (vital capacity and forced exspiratory volume within 1 s), chest X-ray, and arterial blood gas analysis and blood chemistry analysis with an SMA-22 (System Multi Analyzer). At the conclusion of the preoperative evaluation, patients are classified according to ASA physical status, Goldman Cardiac Risk Index and an exercise classification such as NYHA. Only elective surgical patients are evaluated in this clinic. Within the last 15 years more than 75,000 patients have been seen in our preoperative clinic, 91.8% of whom were cleared for surgery and anaesthesia after the initial evaluation. There were 1132 patients who needed preoperative treatment first. Only 4.4% were discharged without operation because too many risk factors for perioperative complications were present. We found that comprehensive preoperative evaluation in this clinic was more efficient than bedside evaluation and reduced examination time for the patient. In 1983 and 1985 we published two prospective/retrospective studies on the improvement of perioperative morbidity and mortality of selected patients undergoing non-cardiac surgery. We found that perioperative complications and adverse outcome correlated with preoperative data and physical examination. The main source of perioperative morbidity and mortality was the cardiovascular system, followed by nephrologic diseases, correlating exactly with preoperative BUN and plasma creatinine. These studies also underlined the value of the ASA physical status to predict perioperative outcome.(ABSTRACT TRUNCATED AT 250 WORDS)