Böhmer A B, Defosse J, Geldner G, Mertens E, Zwissler B, Wappler F
Klinik für Anaesthesiologie und operative Intensivmedizin, Klinikum der Universität Witten/Herdecke, Kliniken der Stadt Köln gGmbH, Ostmerheimer Str. 200, 51109 Köln, Deutschland.
Anaesthesist. 2012 May;61(5):407-19. doi: 10.1007/s00101-012-2019-z. Epub 2012 May 12.
While assessing the medical history and physical examination are the cornerstones of preoperative risk evaluation, the importance of "routine" testing has been critically discussed in recent studies. The joint recommendations of the German Societies of Anaesthesiology and Intensive Care Medicine, Surgery and Internal Medicine for preoperative evaluation of adult patients prior to elective, non-cardiac surgery, which were published in November 2010, are the first comprehensive practice guidelines for preoperative evaluation in Germany. Aim of this study was to analyze former strategies for assessing perioperative risk at anaesthesia departments in Germany.
A 29-item questionnaire concerning general hospital characteristics, strategies for preoperative evaluation and cognizance of the joint recommendations was developed as an online survey. In particular the reasons for technical assessment were surveyed (i.e. routine, patient age or pre-existing conditions, risk of operation being performed). In certain questions multiple answers were permitted. All hospitals with departments of anaesthesiology in Germany were included. Data are presented as percentages.
A total of 396 hospitals (35.6%) completed the questionnaire. Physical examination is not performed regularly (37%) but only when indicated by the medical history. Criteria for performing preoperative electrocardiograms are comorbidities of the cardiovascular (80.1%) and pulmonary systems (42.2%) as well as patient age (52.8%) and as routine measures (10.1%). Laboratory testing was performed as a routine (43.2%) because of patient age (52.8%) or pre-existing conditions (37.3%). Preoperative chest x-ray was carried out when the medical history or physical examination suggest intrathoracic pathologies (81.3%) or was based on patient age (35.9%). The majority of hospitals (89.1%) plan to implement the joint recommendations for preoperative evaluation in the future.
According to the joint recommendations preoperative testing is more and more directed to patients with an increased perioperative risk which is clinically indicated by medical history and physical examination. However, routine or age-related medical testing is still a frequently used strategy. German medical societies should focus on advanced implementation strategies to change current practices in order to avoid unnecessary diagnostic procedures and to increase patient safety and satisfaction.
虽然评估病史和体格检查是术前风险评估的基石，但近期研究对“常规”检查的重要性进行了批判性讨论。德国麻醉学与重症医学、外科学和内科学学会于2010年11月发布的关于成年患者择期非心脏手术术前评估的联合建议，是德国首个全面的术前评估实践指南。本研究的目的是分析德国麻醉科既往评估围手术期风险的策略。
编制了一份包含29个项目的问卷，内容涉及综合医院特征、术前评估策略以及对联合建议的认知，作为在线调查。特别调查了进行技术评估的原因（即常规、患者年龄或既有疾病、所进行手术的风险）。某些问题允许有多个答案。纳入了德国所有设有麻醉科的医院。数据以百分比形式呈现。
共有396家医院（35.6%）完成了问卷。体格检查并非定期进行（37%），而是仅在病史提示时才进行。进行术前心电图检查的标准是心血管系统（80.1%）和肺部系统的合并症（42.2%）、患者年龄（52.8%）以及作为常规措施（10.1%）。实验室检查作为常规进行的比例为43.2%，因患者年龄（52.8%）或既有疾病（37.3%）而进行的比例分别为52.8%和37.3%。当病史或体格检查提示有胸内病变时（81.3%）或基于患者年龄（35.9%）进行术前胸部X线检查。大多数医院（89.1%）计划在未来实施术前评估的联合建议。
根据联合建议，术前检查越来越多地针对围手术期风险增加的患者，这在临床上由病史和体格检查提示。然而，常规或与年龄相关的医学检查仍是常用策略。德国医学学会应专注于先进的实施策略，以改变当前做法，避免不必要的诊断程序，提高患者安全性和满意度。
