Perioperative Systems as a quality model of perioperative medicine and surgical care

Lee, Anna; Kerridge, Ross; Chui, Po Tong; Chiu, Chun Hung; Gin, Tony

doi:10.1016/j.healthpol.2011.05.009

Cited by 61 publications

(54 citation statements)

References 52 publications

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“…22 Recent data indicate a reduction in the number of preoperative investigations when patients are evaluated in preoperative clinics. 4 However, in the present study, most tests were ordered by the ophthalmologist before the patient was seen by a specialist for preoperative evaluation. Cardiac stress tests were ordered only for patients undergoing outpatient preoperative evaluation, and 9% of these patients had a cardiac stress test performed, a rate higher than that reported in the literature (0.8 to 2.4% in low-risk surgery).…”

Section: Discussionmentioning

confidence: 89%

“…3 Aiming to prepare these patients and reduce perioperative complications, preoperative evaluation has become a common practice in recent years. 4 Previous studies show a great variability in the forwarding rate (10 to 40%) [5][6][7] and, despite of the presumed benefits for intermediate-to-high risks patients, the factors that determine whether an individual does or does not undergo preoperative evaluation remain unclear.…”

Section: Introductionmentioning

confidence: 99%

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The impact of preoperative evaluation on perioperative events in patients undergoing cataract surgery: a cohort study

Alboim

Kliemann

Soares

et al. 2016

Eye

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Purpose Ambulatory surgery is a major area of surgical and anesthetic practice, and preoperative clinics are being increasingly used for low-risk surgical procedures. This study investigated the impact of preoperative evaluation on perioperative events in patients undergoing cataract surgery. Methods This was a retrospective cohort study of 968 consecutive patients undergoing cataract surgery. Details of medical conditions, surgical, anesthetic, and postoperative information were collected from medical records. A logistic regression model was developed using propensity score adjustment for baseline characteristics. Results Out 968 patients included, 240 (24.7%) underwent outpatient preoperative evaluation. There were no perioperative major cardiovascular events. Hypertension occurred in 319 (33%) patients, accounting for 79.7% of all adverse events. Preoperative evaluation resulted in a lower hypertension rate after adjustment for propensity score (OR = 0.6; 95% CI 0.41-0.93); no effects were observed on posterior capsule rupture and emergency visits/hospitalization within 7 days of surgery. Eighty-nine patients (9.3%) had an initial systolic pressure ≥ 180 mm Hg, which was not associated with higher risk of posterior capsule rupture (P = 0.158) or postoperative adverse events (P = 0.902). Median waiting time to surgery was 6 and 2 months for evaluated and non-evaluated patients, respectively (Po0.001). Conclusions In the context of low-risk surgery and no major perioperative and postoperative outcomes, it appears that outpatient preoperative evaluation has no role in reducing adverse events in cataract surgery candidates. Despite fewer hypertensive episodes observed in evaluated patients, these episodes were not associated with any medical or surgical outcomes.

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Section: Discussionmentioning

confidence: 89%

Section: Introductionmentioning

confidence: 99%

The impact of preoperative evaluation on perioperative events in patients undergoing cataract surgery: a cohort study

Alboim

Kliemann

Soares

et al. 2016

Eye

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“…It has been suggested by Lee et al that including patient in the planning process to reduce patient related cancellations especially poor preoperative investigations. 16 Dufek et al recommended improvement of protocol for preoperative patient evaluation improving the timeliness response by physician. 17 In most of studies related to cancellations, planning and scheduling of elective surgery is focused while one of the common reason for cancelling elective surgery is emergency surgery given higher priority.…”

Section: Discussionmentioning

confidence: 99%

Causes of cancellation for elective orthopedic procedures on the day of surgery

Karnalkar¹,

Karnalkar²

2015

Int J Sci Rep

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INTRODUCTIONThe cost of health care delivery is increasing everyday. Hence there is need for healthcare teams to encourage cost effectiveness in every aspect of patient care. It also leads to prolonged hospital stay and in many cases repetition of various aspects of pre-operative preparation. Apart from economic loss to hospital, it is also stressful for patients and their families. All of these increase patients therapeutic expense. Avoidance of cancellation of elective surgery, therefore should lead to reduction in the overall cost of treatment.In UK 8% of scheduled elective operations are cancelled nationally, within 24 hours of surgery.1 In total 10 to 40% of booked elective operations are cancelled before the surgery takes place. The reasons include cancellation by the patient, cancellation for poorly optimized medical conditions or cancellations due to poor organization, lack of co-ordination among the surgical team and the anaesthetist, or sometimes poor co-ordination between the patient and the hospital administration.2 A variety of studies have examined the reasons for late cancellations based on the retrospective analysis of hospital records. [3][4][5][6][7][8][9][10][11][12] This audit was a retrospective study in a medical teaching hospital. The aim was to assess the causes of cancellation of orthopedic procedures scheduled on day of surgery and ABSTRACT Background: A retrospective observational study was conducted to find out the reasons for cancellation of elective orthopedic surgical inpatients on the day of surgery and to plan for future suggestive actions to decrease unnecessary cancellations. Methods: This was a retrospective observational study conducted at medical teaching hospital for 3 years from January 1, 2012 to December 31, 2014. The data was collected from postponement register. The files of cases that were cancelled were reviewed for the reasons of cancellations. The reasons were classified as anaesthetist related, administrative issues, surgeon related and patient related issues. Results: During the study period, 7673patients were posted for elective orthopedic procedures. 6.49 % patients were cancelled on the day of surgery. The frequency of cancellations was more in anesthetist related issues (38.9%). Cancellations due to administrative issues, patient related issues and surgeon related were 30%, 27.7% & 3.4% respectively. Conclusions: Although cancellations were only 6.49% of total elective operations, this can be reduced by implementing and following the recommendations that have been proposed. More thorough and detailed documentation is needed to achieve this.

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“…The DOSC rate ranges from 1.96% to 36.4% for numerous reasons. 4,5 As an indicator of quality of care, a surgical cancellation rate of less than 5% is recommended. 6 Surgical cancellations decrease hospital income, and are costly to patients in terms of lost productivity and emotional distress.…”

Section: Introductionmentioning

confidence: 99%

Economic and psychological burden of scheduled surgery cancellation in a sub-Saharan country (Burkina Faso)

Lankoande

Bonkoungou

Ki³

et al. 2017

Southern African Journal of Anaesthesia and Analgesia

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Background: Cancellation of scheduled surgery creates a financial burden for hospitals, caregivers and patients. Cancellation causes emotional stress, which impacts on outcomes. In poor countries where the adequacy of healthcare is limited, the ethical dilemma created by scheduled surgery cancellation is particularly important. Objective: To identify the incidence, cost and emotional impact of elective surgical cancellation in a teaching hospital in Burkino Faso. Methods: A four month, prospective, observational study was undertaken in a teaching hospital (Yalgado Ouedraogo). All surgical patients were eligible. The causes of cancellation, financial cost and patients' emotional response were assessed. The cost was estimated using a tool adapted for the economic cost of African job types. Results: During the study period, 1 088 cases were scheduled to undergo inpatient surgery. Of these, 239 cases (21.9%) were cancelled. Among the cancelled cases, 237 were cancelled during preparation in the surgical ward and two cases were cancelled in the operation room. A large number of the patients were housewives (n = 87). The highest cancellation rate (35.9%) was found in general surgery. Cancellation was judged avoidable in 214 cases (89.5%). The total cost of surgery cancellation to the hospital was US$ 19 147 (mean value US$ 80 per patient). Patients lost a mean of US$ 62.70, which represented 117.6% of the official average monthly income in Burkina Faso. ENT surgery was the costliest to the hospital (US$ 4 989 ). Cancellation caused a negative emotional reaction in 205 patients (85.7%) and 'sadness' was the most frequent (54.8%; n = 131). Cancellation resulted in 163 days of work lost. Conclusion: Based on income, the cost of day of surgery cancellation was high in Burkina Faso.

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Perioperative Systems as a quality model of perioperative medicine and surgical care

Cited by 61 publications

References 52 publications

The impact of preoperative evaluation on perioperative events in patients undergoing cataract surgery: a cohort study

The impact of preoperative evaluation on perioperative events in patients undergoing cataract surgery: a cohort study

Causes of cancellation for elective orthopedic procedures on the day of surgery

Economic and psychological burden of scheduled surgery cancellation in a sub-Saharan country (Burkina Faso)

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