Pre-surgery exam rates vary widely among hospitals

December 21, 2011

Hospitals vary greatly in the number of patients who see an internal medicine specialist before major non-cardiac surgery, with rates ranging from five per cent of patients to 90 per cent, new research has found.

The findings are important because they suggest there are no commonly agreed upon standards for which patients should have such consultations, said Dr. Duminda Wijeysundera, a scientist at the Li Ka Shing Knowledge Institute of St. Michael's Hospital and the Institute for Clinical Evaluative Sciences (ICES).

As a result, some patients may be getting expensive tests and exams they don't need, while others who do need them are not getting them, said Dr. Wijeysundera, who is also an at Toronto General Hospital-University Health Network.

Dr. Wijeysundera studied the records of 205,000 patients who underwent major elective non-cardiac surgery in 79 hospitals in Ontario from 2004 to 2009. His results were published today in the journal Anesthesiology.

All patients scheduled for in Ontario must undergo a preoperative and physical, which are typically done by the patient's or surgeon. Referrals to an internal medicine specialist are usually made at the discretion of the surgeon or anesthesiologist.

One-third of the patients studied underwent a pre-operative medical consultation. Not surprisingly, most were older, were patients at or hospitals with high volumes of surgery, or had other, pre-existing medical conditions such as diabetes or .

However, the rates varied widely from hospital to hospital, and could not be explained based on the surgical procedure, the volume of surgeries conducted at the hospital or whether it was a teaching hospital.

"That suggests the forces driving this have little to do with how sick the patient is," Dr. Wijeysundera said. "Further research is needed to better understand the basis for this inter-hospital variation and to determine which patients benefit most from pre-operative consultation."

More research is also needed to determine whether the difference may be explained by individual surgeon's preferences, he said.

Dr. Wijeysundera said pre-operative consultations may be helpful for patients with other medical issues, because it's an opportunity to document and/or treat those pre-existing conditions and take steps to lower their risks for surgery, or even cancel the procedure.

But previous studies have found no clear evidence that these consultations improve patient outcomes. In fact, the studies have suggested the tests and examinations may be associated with longer hospital stays, more post-operative complications and even a slightly higher death rate.

"When performed in patients who are unlikely to benefit from them, these consultations can increase healthcare costs, while exposing some individuals to unnecessary and potentially harmful tests or interventions," he said.

Explore further: Not all hospitals treat elderly the same

Related Stories

Recommended for you

Outside the body, a heart beats via life-saving system

September 1, 2015

(Medical Xpress)—A system that enables heart transplants involving hearts that stopped beating in the donor's body continues to save lives. The Organ Care System (OCS) has been used in UK hospitals with good results.

A recipe for long-lasting livers

April 22, 2015

People waiting for organ transplants may soon have higher hopes of getting the help that they need in time. Researchers at the RIKEN Center for Developmental Biology have developed a new technique that extends the time that ...

Surgeon to offer ideas on a way to do human head transplants

February 26, 2015

Sergio Canavero of the Turin Advanced Neuromodulation Group has made it known that he intends to announce at this summer's American Academy of Neurological and Orthopedic Surgeons meeting, that he believes he has put together ...

New tool helps guide brain cancer surgery

July 3, 2014

A tool to help brain surgeons test and more precisely remove cancerous tissue was successfully used during surgery, according to a Purdue University and Brigham and Women's Hospital study.


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.