Background: Each year 45 million procedures are performed in the United States. For elective procedures, the preoperative evaluation is an opportunity to identify and manage risk factors that may contribute to post -operative morbidity and mortality. Increasingly thispre-operative visit has come under the purview of hospital medicine. While studies have demonstrated that pre-operative evaluations reduce costly cancellations and delays, less is known about how hospitalist led preoperative clinics are utilized. In thisabstract we describe the utilization patterns for hospitalist pre-admission testing (PAT) clinics at an academic medical center for patients undergoing elective surgery.
Methods: This study was reviewed and approved by the Institutional Review Board.This is a retrospective study conducted at two urban, tertiary care, academic hospitals belonging to the same academic health center. A list of all patients on the surgical schedule between January 1,2007 and December 31,2011 for both hospitals was obtained. A random number generator selected 1400 patients from this list. A research assistant was trained to review the electronic medical records to identify if patients hadbeen evaluated in the hospitalist pre-operative clinic in the preceding 30 days, extract demographics, surgical characteristics, medical co-morbidities and complications during the hospital stay. To adjust for the higher probability of a pre-operative evaluation being requested for more complex patientswhen assessing clinical outcomes, a propensity score was created. A logistic regression model using patientand surgical characteristics as predictors and a PAT visit as the outcome (Y/N) generated predicted (propensity) scores from the model.
For patient undergoing elective surgery the distribution of the American Society of Anesthesiologist (ASA) scores and propensity scores were compared between patients seen in the pre-operative clinic and those who were not seen in the pre-operative clinic. The ASA score is a global measure of the physical status of the patient prior to surgery. A score of 1 denotes a normal, healthy patient while a score of 5 is assigned to patients who are unlikely to survive surgery. Data was summarized using mean(SD) and count (percent) and compared between groups using Student t-test or Fisher’s Exact test.
Results: Of the 1400 patients, 752underwent elective surgery. Most patients had an ASA class of 3 (n=544, 72.3%) The next most frequent ASA class was ‘2’(n=130,17.2%)Of the patients undergoing elective surgery, 207 (27.5%)were seen in the PAT.There was no association between the ASA score and PAT visit (p-value-0.497). However, there was a statistically significant association between propensity scores and PAT visits. (p <0.0001)
Conclusions: There was no correlation between ASA scoresand referral to a Hospitalist for pre-operative assessment.This finding underscores the need fora triage scoring system other than the ASA to determine who should be referred for preoperative medical consultation.Surgeons may refer patients to hospitalists for a preoperative evaluation for reasons unrelated to underlying medical co-morbidity as measured by the ASA. Refining the criteria for hospitalist pre-operative clinic may help us utilize and direct resources to the patients who need them most.