Cost-effectiveness of preoperative examinations

Preoperative medical evaluation is needed to assess individual patients risks of perioperative morbidity and mortality. The content of the preoperative examination remains the object of discussion. Although a well documented preoperative assessment of a patient's health status might allow to optimise his condition before surgery and to plan the most appropriate perioperative management, leading to an improvement of perioperative outcome as well as a reduction in costs, data to support this claim are still most often indirect. A large number of patients remain asymptomatic, with normal tests, which raises questions about the appropriateness to request a battery of tests on every candidate to surgery. Patients risks should be assessed mainly by history and physical examination, which might reduce drastically preoperative indication of laboratory tests: age, operation site, preoperative diseases and emergent surgery are important factors to consider. A risk estimate is presented, as well as recommendations for a preoperative health assessment, by categories of patients, following a screening pathway. Costs have been estimated in various alternatives. They have been evaluated to be above 2 billion BEF per year in Belgium for 563,485 surgical cases, and could most likely be reduced by about 60% in a near future.