Takeaway

Preoperative evaluations didn't decrease hemodynamic and respiratory complications or inpatient length of stay.

Key Points

• 1117 patients
• Prospective observational study
• Patients aged 18 to 80 who underwent elective surgery
• Hemodynamic and respiratory complications observed in 545 patients within the first 24 h intraoperatively and postoperatively

Excerpts

Preoperative assessments for surgical patients aim to identify potential risks during the perioperative period, improve the patient’s functional and physiological condition, and reduce the likelihood of complications

Medical specialists perform preoperative assessments for 10–40% of patients undergoing elective surgery. However, the number of studies showing the effects of preoperative anesthesia evaluation on patient safety is limited in the literature

Research estimates suggest that approximately 30% of total healthcare expenditures are associated with medical interventions that offer minimal or no clinical benefit

Our research aimed to evaluate whether these assessments effectively mitigate the risks associated with surgical procedures by examining their influence on patient outcomes during the perioperative period.

No relationship was detected between preoperative evaluations and consultations and the occurrence of hemodynamic and respiratory complications. High ASA score, history of COPD and asthma were associated with perioperative hemodynamic and respiratory complications.

We found that patients with age, coronary artery disease, and high ASA scores were more likely to be consulted for perioperative complications.

The absence of a clear association between complications and preoperative evaluations suggests the need for improvements in identifying target populations, refining evaluation processes, and optimizing interventions.

Partridge et al. showed that detailed evaluation of geriatric patients before vascular surgery shortens the length of hospital stay [23]. Another study found that preoperative evaluations reduced the mortality rate in patients classified as ASA 3 or higher [24]. Both studies focused on high-risk patients and demonstrated positive effects of comprehensive preoperative evaluations on the measured outcomes. In contrast, our study involved elective and non-high-risk patients, which may explain the differences between our findings and those of both studies.

the duration from the initial evaluation to the surgical procedure was significantly prolonged in patients for whom consultations were requested. This finding highlights the need for a more streamlined approach to preoperative evaluations, focusing on relevant assessments that effectively mitigate risks without contributing to delays in surgical intervention.

Although consultations were requested based on certain risk factors (e.g., age, ASA score), they did not significantly reduce the incidence of hemodynamic and respiratory complications. However, requested consultations did lead to a longer surgical waiting time. A personalized preoperative assessment and consultation, tailored to the individual’s risks and benefits, could optimize the healthcare system’s limited resources and potentially improve patient outcomes.

Abstract

Background

The impact of routine preoperative anesthesia evaluations on potential perioperative complications remains unclear. This study aimed to investigate the effect of preoperative evaluation on early perioperative hemodynamic and respiratory complications.

Methods

This prospective observational study analyzed data from patients aged 18 to 80 who underwent elective surgery between October 15, 2023, and February 15, 2024. The study evaluated the effect of preoperative anesthesia evaluation on hemodynamic and respiratory complications occurring during surgery and within the first 24 h postoperatively, as well as its impact on the length of hospital stay.

Results

The analysis included 1117 patients for whom complete data was available. Hemodynamic and respiratory complications were observed in 545 patients (48.7%), occurring within the first 24 h intraoperatively and postoperatively. Because no additional examinations beyond routine blood tests, radiological imaging, and electrocardiograms were performed in the preoperative period, the impact of these tests on the development of hemodynamic and respiratory complications could not be determined. There was no statistically significant association between the presence or absence of preoperative consultation and the occurrence of early perioperative hemodynamic and respiratory complications [OR (95% CI): 0.879 (0.646–1.195); P = 0.411], nor did it affect the length of hospital stay [median (IQR); 2 (3) vs. 2 (3); P = 0.245].

Conclusion

While the impact of routinely requested laboratory and imaging methods before surgery could not be assessed in this study, consultations that were requested did not affect hemodynamic and respiratory complications in the early perioperative period or on the duration of hospital stay.

Citation

Komurcu O, Genc C, Kurt BC, Demir O, Akbaş A, Akyurt D, Kuşderci HS, Tulgar S, Süren M. Preoperative evaluation: Impact on early perioperative hemodynamic and respiratory complications. BMC Anesthesiol. 2024 Nov 27;24(1):435. doi: 10.1186/s12871-024-02821-1. PMID: 39604844; PMCID: PMC11600558.

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