Outpatient internal medicine preoperative evaluation: a randomized clinical trial

Area of Science:

• Internal Medicine
• Health Services Research
• Surgical Pre-assessment

Background:

• Preoperative evaluation is crucial for optimizing patient care before elective surgery.
• Traditional inpatient preoperative evaluations can lead to prolonged hospital stays and increased resource utilization.
• Outpatient models offer a potential alternative to streamline the preoperative process.

Purpose of the Study:

• To evaluate the impact of an outpatient internal medicine preoperative evaluation program on resource use.
• To compare the length of stay and unnecessary admissions between outpatient and inpatient preoperative evaluation arms.

Main Methods:

• A randomized clinical trial with a two-arm parallel design was conducted.
• 355 patients undergoing elective surgery were randomized to either an inpatient or outpatient preoperative evaluation arm.
• Key outcome measures included preoperative, postoperative, and total length of stay, as well as unnecessary admissions.

Main Results:

• Outpatient preoperative evaluation significantly reduced preoperative length of stay (1.6 days vs. 2.9 days).
• Unnecessary admissions were significantly decreased in the outpatient arm (5.7% vs. 12.3%).
• No significant differences were observed in total length of stay, laboratory tests, or imaging tests between the arms.

Conclusions:

• An outpatient internal medicine preoperative evaluation program effectively reduces preoperative length of stay.
• This program also significantly decreases unnecessary patient admissions prior to elective surgery.
• The findings support the implementation of outpatient preoperative evaluations to enhance efficiency in surgical care pathways.