Nurse-led versus doctor-led preoperative assessment for elective surgical patients requiring regional or general anaesthesia

Nicholson, Amanda; Lewis, Sharon R; Coldwell, Chris H; Smith, Andrew F.

doi:10.1002/14651858.cd010160

Cited by 11 publications

(10 citation statements)

References 22 publications

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“…This analysis includes data from 409 trials, extracted from 37 Cochrane reviews , representing 51 countries with 89,389 participants. Trial selection is shown in Fig.…”

Section: Resultsmentioning

confidence: 99%

The developing world of pre‐operative optimisation: a systematic review of Cochrane reviews

2018

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Pre-operative optimisation is a heterogenous group of interventions aimed at improving peri-operative outcomes. To understand the evidence for pre-operative optimisation in the developing world, we systematically reviewed Cochrane reviews on the topic according to the Human Developmental Index (HDI) of the country where patient recruitment occurred. We used summary statistics and cartograms to describe the HDI, year of publication, timing of pre-operative intervention and risk of bias associated with each included trial. We assessed the impact of multinational trials on the risk of bias introduced by countries of differing HDI. Fourhundred and nine trials representing 51 countries and 89,389 randomly allocated participants were summarised in this review. Four-hundred and nineteen out of 451 (93%) trial populations (i.e. a group of study participants from one country) were from high and very high HDI countries. The median (IQR [range]) HDI of countries were 0.862 (0.806-0.892 [0.445-0.949]). Three of the 409 included trials were multinational, representing 32 countries and 37,736 out of 89,389 (42.2%) included participants. Africa was the least represented continent, with only 4 included trials and 566 participants, of which 62.3% were from one multinational trial. The overall risk of bias was high or unclear in 381 out of 409 (93%) trials. Inclusion of multinational trials decreased the proportion of trial populations introducing high or unclear risk of bias by 9.4% (95%CI 5.1-13.7; p < 0.0001). Half of the world's population live in low-and middle-HDI countries. This population is poorly represented in systematically reviewed evidence on pre-operative optimisation. Multinational trials increase the knowledge contribution from low-and middle-HDI countries and decrease risk of bias in systematic reviews. Anaesthesia 2019, 74, 89-99 du Toit et al. | Developing world of pre-operative optimisation

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“…This analysis includes data from 409 trials, extracted from 37 Cochrane reviews , representing 51 countries with 89,389 participants. Trial selection is shown in Fig.…”

Section: Resultsmentioning

confidence: 99%

The developing world of pre‐operative optimisation: a systematic review of Cochrane reviews

2018

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“…Nicholson et al . () did not find enough evidence about the effectiveness of nurse‐led preoperative assessment, but this review strongly suggests the usefulness and the positive outcomes of preoperative nursing. The role of a preoperative nurse in a preoperative setting is essential.…”

Section: Discussionmentioning

confidence: 99%

“…Only two trials were included into the study, and not enough evidence was found about the effectiveness of nurse‐led preoperative assessments (Nicholson et al . . ).…”

Section: Introductionmentioning

confidence: 97%

An integrative review of a preoperative nursing care structure

Turunen

Miettinen

Setälä

et al. 2017

Journal of Clinical Nursing

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“…Since the introduction of our speciality, anaesthesiologists have been at the forefront of attempts to improve patient safety [ 1 ]. For preoperative risk evaluation and modification, preoperative assessment is widely introduced to obtain information about the patient’s state of health and to collect data on previous treatments [ 2 , 3 ]. The ultimate goals of preoperative assessment are to evaluate perioperative risk, optimise patient status and to reduce the patient’s surgical and anaesthetic morbidity or mortality [ 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

The preoperative cardiology consultation: indications and risk modification

et al. 2017

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BackgroundThe cardiologist is regularly consulted preoperatively by anaesthesiologists. However, insights into the efficiency and usefulness of these consultations are unclear.MethodsThis is a retrospective study of 24,174 preoperatively screened patients ≥18 years scheduled for elective non-cardiac surgery, which resulted in 273 (1%) referrals to the cardiologist for further preoperative evaluation. Medical charts were reviewed for patient characteristics, main reason for referring, requested diagnostic tests, interventions, adjustment in medical therapy, 30-day mortality and major adverse cardiac events.ResultsThe most common reason for consultation was the evaluation of a cardiac murmur (95 patients, 35%). In 167 (61%) patients, no change in therapy was initiated by the cardiologist. Six consultations (2%) led to invasive interventions (electrical cardioversion, percutaneous coronary intervention or coronary artery bypass surgery). On average, consultation delayed clearance for surgery by two weeks.ConclusionIn most patients referred to the cardiologist after being screened at an outpatient anaesthesiology clinic, echocardiography is performed for ruling out specific conditions and to be sure that no further improvement can be made in the patient’s health. In the majority, no change in therapy was initiated by the cardiologist. A more careful consideration about the potential benefits of consulting must be made for every patient.

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Nurse-led versus doctor-led preoperative assessment for elective surgical patients requiring regional or general anaesthesia

Cited by 11 publications

References 22 publications

The developing world of pre‐operative optimisation: a systematic review of Cochrane reviews

The developing world of pre‐operative optimisation: a systematic review of Cochrane reviews

An integrative review of a preoperative nursing care structure

The preoperative cardiology consultation: indications and risk modification

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