This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (23) Citing Articles via Google Scholar Google Scholar Articles by van Klei, W. A. Articles by Grobbee, D. E. Search for Related Content PubMed PubMed Citation Articles by van Klei, W. A. Articles by Grobbee, D. E. Related Collections Ambulatory

---

ECONOMICS AND HEALTH SYSTEMS RESEARCH

The Effect of Outpatient Preoperative Evaluation of Hospital Inpatients on Cancellation of Surgery and Length of Hospital Stay

Wilton A. van Klei, MD MSc^*, Karel G.M. Moons, PhD^*, Charles L.G. Rutten, MD PhD, Anke Schuurhuis, MD^*, Johannes T.A. Knape, MD PhD^*, Cornelis J. Kalkman, MD PhD^*, and Diederick E. Grobbee, MD PhD

*Department of Peri-operative Care, Anesthesia, and Pain Management, and Julius Center for General Practice and Patient Oriented Research, University Medical Center Utrecht, The Netherlands; and Department of Anesthesiology, Isala Clinics, Weezenlanden Hospital, Zwolle, The Netherlands

Address correspondence and reprint requests to Wilton van Klei, MD, MSc, Department of Peri-operative Care, Anesthesia, and Pain Management, hp E03.511, University Medical Center Utrecht, PO Box 85500, 3508 GA, Utrecht, The Netherlands. Address e-mail to w.a.vanklei{at}azu.nl

To evaluate the possible effects of outpatient preoperative evaluation (OPE) for new surgical patients who will be inpatients, we conducted an observational study at a university hospital in The Netherlands. Various outcomes before and after the introduction of an OPE clinic were compared. The study population comprised all 21,553 elective adult inpatients operated on between January 1, 1997 and December 31, 1999. Cardiac surgery, obstetric and pediatric patients, and patients operated on in same-day surgery were excluded. The main outcome measures were surgical cases canceled for medical reasons, rate of same-day admissions (who were expected to increase), and length of hospital stay. After introduction of OPE, the rate of cancellations for medical reasons decreased from 2.0% to 0.9% (adjusted odds ratio 0.7, 95% CI, 0.5–0.9). The rate of same-day admissions increased from 5.3% before to 7.7% after OPE introduction (adjusted odds ratio 1.2, 95% CI, 1.01–1.39), and the total hospital length of stay (in days) significantly decreased by a factor of 0.92 (0.90–0.94), which was partly the result of a reduction in preoperative admission time. We concluded that, although smaller than anticipated, the use of OPE for potential inpatients leads to a significant reduction of cancelled cases and of length of admission. Further increase of these benefits from OPE requires changes in institutional policy, such as forcing surgical departments to increase their number of same-day admissions.

IMPLICATIONS: An observational study was conducted to compare various outcomes before and after the introduction of outpatient preoperative evaluation (OPE). Although smaller than anticipated, OPE for potential inpatients leads to a significant reduction of canceled cases and of length of admission.

This article has been cited by other articles:

				M. E. Zonderland, F. Boer, R. J. Boucherie, A. de Roode, and J. W. van Kleef Redesign of a University Hospital Preanesthesia Evaluation Clinic Using a Queuing Theory Approach Anesth. Analg., November 1, 2009; 109(5): 1612 - 1621. [Abstract] [Full Text] [PDF]

				D. N. Wijeysundera, P. C. Austin, W. S. Beattie, J. E. Hux, and A. Laupacis A Population-Based Study of Anesthesia Consultation Before Major Noncardiac Surgery Arch Intern Med, March 23, 2009; 169(6): 595 - 602. [Abstract] [Full Text] [PDF]

				L. C. Lemmens, H. E. Kerkkamp, W. A. van Klei, N. S. Klazinga, C. L. Rutten, R. H. van Linge, and K. G. Moons Implementation of outpatient preoperative evaluation clinics: facilitating and limiting factors Br. J. Anaesth., May 1, 2008; 100(5): 645 - 651. [Abstract] [Full Text] [PDF]

				G. M. Edward, L. C. Lemaire, B. Preckel, F. J. Oort, M. J. L. Bucx, M. W. Hollmann, and J. C. J. M. de Haes Patient Experiences with the Preoperative Assessment Clinic (PEPAC): validation of an instrument to measure patient experiences Br. J. Anaesth., November 1, 2007; 99(5): 666 - 672. [Abstract] [Full Text] [PDF]

				N. F. Holt, D. G. Silverman, R. Prasad, J. Dziura, and K. J. Ruskin Preanesthesia Clinics, Information Management, and Operating Room Delays: Results of a Survey of Practicing Anesthesiologists Anesth. Analg., March 1, 2007; 104(3): 615 - 618. [Abstract] [Full Text] [PDF]

				F. Dexter, E. Marcon, R. H. Epstein, and J. Ledolter Validation of Statistical Methods to Compare Cancellation Rates on the Day of Surgery Anesth. Analg., August 1, 2005; 101(2): 465 - 473. [Abstract] [Full Text] [PDF]

				L. R. Ferrari Preoperative Evaluation of Pediatric Surgical Patients with Multisystem Considerations Anesth. Analg., October 1, 2004; 99(4): 1058 - 1069. [Abstract] [Full Text] [PDF]

				D. L. Hepner, A. M. Bader, S. Hurwitz, M. Gustafson, and L. C. Tsen Patient Satisfaction with Preoperative Assessment in a Preoperative Assessment Testing Clinic Anesth. Analg., April 1, 2004; 98(4): 1099 - 1105. [Abstract] [Full Text] [PDF]

				J. Pollard and W. A. van Klei Optimizing the Benefits of Outpatient Preoperative Anesthesia Evaluation * Response Anesth. Analg., November 1, 2002; 95(5): 1461 - 1461. [Full Text] [PDF]