The value to the anesthesia-surgical care team of the preoperative cardiac consultation

Kleinman, Bruce; Czinn, Edward A.; Shah, Kamlesh; Sobotka, Paul; Rao, Tadikonda K.

doi:10.1016/s0888-6296(89)94472-4

Cited by 26 publications

(15 citation statements)

References 17 publications

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“…It might be originated from vague understanding of consultation procedures. In a previous retrospective review of 202 cardiology consultations at a university hospital, it was found that only 108 asked for evaluations, 79 asked for a clearance, and 9 did not specifically ask for anything [2]. Our study showed similar results.…”

supporting

confidence: 83%

Characteristics and effectiveness of preoperative consultations in a tertiary hospital

Paik

Lim

Ryu

2013

Korean J Anesthesiol

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supporting

confidence: 83%

Characteristics and effectiveness of preoperative consultations in a tertiary hospital

Paik

Lim

Ryu

2013

Korean J Anesthesiol

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“…These physicians all have offices outside our hospital and are on the staff of at least one other hospital than our own. In addition, other studies than our own have found questionable impact on patient management by medical and cardiology consults 4 as well as lack of specificity as to the reasons for requesting a consult 4,5 and frequently poor communication between consultants and other physicians. 1,5 It seems unlikely, therefore, that our results could be unique to any particular institution.…”

Section: Discussionmentioning

confidence: 67%

“…3 Kleinmann found that very few anesthesiologists or surgeons specify what is being requested when asking for a cardiology consult. 4 Lee 1 documented that in 14% of cases, requesting physicians and medical consultants actually disagreed on the reasons for the consult. Rudd,5 in a study on preoperative medical consultations for diabetic patients, found that no specific question was asked by the requesting physician in 24% of cases, and in 12%, consulting physicians ignored the questions that were asked.…”

Section: Conclusion : Une Revue De 146 Consultations Médicales Montrementioning

confidence: 99%

Preoperative medical consultations: impact on perioperative management and surgical outcome

Katz

Cimino

Vitkun

2005

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : This study was designed to assess the effect of preoperative medical consults on both perioperative management and surgical outcome.M Me et th ho od ds s: : The charts of 387 consecutive patients over the age of 50 undergoing non-cardiac, elective surgery during a six-week period were retrospectively examined. Patient factors including age, ASA status, gender, type of surgery, outcome (death, unexpected intensive care unit admission or uncomplicated discharge), presence of medical consult, and, in those cases where a medical consult was present, stated reason for the consult, the ordering physician, and recommendations of the consultant, were recorded. R Re es su ul lt ts s: : 138 patients receiving medical consults (35.7%) were identified (a total of 146 consults). The most common stated purpose of the consults examined was "preoperative evaluation." In only five consults (3.4%) did the consultant identify a new finding. Sixty-two consults (42.5%) contained no recommendations. There was no statistically significant difference in outcome between those patients who received a medical consult and those who did not.C Co on nc cl lu us si io on n: : A review of 146 medical consults suggests that the majority of such consults give little advice that truly impacts either perioperative management or outcome of surgery. NESTHESIOLOGISTS and surgeons frequently request preoperative consultation from internists and family practitioners for patients with pre-existing or suspected disease. There can be considerable confusion, however, amongst physicians regarding both the reasons for which a consult was requested 1 and the ultimate purposes that the consult serves. Objectif : Évaluer l'effet des consultations médicales préopératoires2 Such confusion often results in consultants' recommendations being ignored.3 Kleinmann found that very few anesthesiologists or surgeons specify what is being requested when asking for a cardiology consult.4 Lee 1 documented that in 14% of cases, requesting physicians and medical consultants actually disagreed on the reasons for the consult. Rudd, 5 in a study on preoperative

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“…This finding is not consistent with previous reports of major surgery where patients were selectively referred for preoperative medical consultations because of medical problems. 14,24 A selective approach based on medical problems was recommended by the authors of a cost-benefit evaluation of preoperative and postoperative medical evaluation 25 and is consistent with the updated American Society of Anesthesiologists Practice advisory for preanesthesia evaluation. 10 …”

Section: Discussionmentioning

confidence: 95%

Patterns of Preoperative Consultation and Surgical Specialty in an Integrated Healthcare System

et al. 2013

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Background Many patients scheduled for elective surgery are referred for a preoperative medical consultation. Only limited data are available on factors associated with preoperative consultations. The authors hypothesized that surgical specialty contributes to variation in referrals for preoperative consultations. Methods This is a cohort study using data from Group Health Cooperative, an integrated healthcare system. The authors included 13,673 patients undergoing a variety of common procedures—primarily low-risk surgeries—representing six surgical specialties, in 2005–2006. The authors identified consultations by family physicians, general internists, pulmonologists, or cardiologists in the 42 days preceding surgery. Multivariable logistic regression was used to estimate the association between surgical specialty and consultation, adjusting for potential confounders including the revised cardiac risk index, age, gender, Deyo comorbidity index, number of prescription medications, and 11 medication classes. Results The authors found that 3,063 (22%) of all patients had preoperative consultations, with significant variation by surgical specialty. Patients having ophthalmologic, orthopedic, or urologic surgery were more likely to have consultations compared with those having general surgery—adjusted odds ratios (95% CI) of 3.8 (3.3–4.2), 1.5 (1.3–1.7), and 2.3 (1.8–2.8), respectively. Preoperative consultations were more common in patients with lower revised cardiac risk scores. Conclusion There is substantial practice variation among surgical specialties with regard to the use of preoperative consultations in this integrated healthcare system. Given the large number of consultations provided for patients with low cardiac risk and for patients presenting for low-risk surgeries, their indications, the financial burden, and cost-effectiveness of consultations deserve further study.

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The value to the anesthesia-surgical care team of the preoperative cardiac consultation

Cited by 26 publications

References 17 publications

Characteristics and effectiveness of preoperative consultations in a tertiary hospital

Characteristics and effectiveness of preoperative consultations in a tertiary hospital

Preoperative medical consultations: impact on perioperative management and surgical outcome

Patterns of Preoperative Consultation and Surgical Specialty in an Integrated Healthcare System

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