van Klei Wilton A, Moons Karel G M, Rutten Charles L G, Schuurhuis Anke, Knape Johannes T A, Kalkman Cornelis J, Grobbee Diederick E
Department of Peri-operative Care, University Medical Center Utrecht, The Netherlands.
Anesth Analg. 2002 Mar;94(3):644-9; table of contents. doi: 10.1097/00000539-200203000-00030.
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.
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.
为评估门诊术前评估（OPE）对即将住院的新手术患者可能产生的影响，我们在荷兰的一家大学医院开展了一项观察性研究。比较了开设OPE门诊前后的各项结果。研究对象包括1997年1月1日至1999年12月31日期间接受手术的所有21553例择期成年住院患者。心脏手术患者、产科和儿科患者以及当日手术患者被排除在外。主要观察指标为因医疗原因取消的手术病例、当日入院率（预计会增加）以及住院时间。引入OPE后，因医疗原因取消手术的比例从2.0%降至0.9%（调整后的优势比为0.7，95%置信区间为0.5 - 0.9）。当日入院率从引入OPE前的5.3%升至7.7%（调整后的优势比为1.2，95%置信区间为1.01 - 1.39），总住院天数显著减少了0.92倍（0.90 - 0.94），这部分是术前住院时间缩短的结果。我们得出结论，尽管规模小于预期，但对潜在住院患者使用OPE可显著减少取消病例数和住院时间。要进一步提高OPE带来的这些益处，需要改变机构政策，比如迫使外科科室增加当日入院患者数量。
开展了一项观察性研究以比较引入门诊术前评估（OPE）前后的各项结果。尽管规模小于预期，但对潜在住院患者使用OPE可显著减少取消病例数和住院时间。
