实施医院医师管理的术前门诊后的围手术期流程和结果。

Perioperative processes and outcomes after implementation of a hospitalist-run preoperative clinic.

机构信息

Department of Medicine, Hospitalist Division, VA Greater Los Angeles Healthcare System, David Geffen School of Medicine at UCLA, Los Angeles, CA 90073, USA.

出版信息

J Hosp Med. 2012 Nov-Dec;7(9):697-701. doi: 10.1002/jhm.1968. Epub 2012 Sep 7.

DOI:10.1002/jhm.1968

PMID:22961756

Abstract

BACKGROUND

A structured, medical preoperative evaluation may positively impact the perioperative course of medically complex patients. Hospitalists are in a unique position to assist in preoperative evaluations, given their expertise with inpatient medicine and postoperative surgical consultation.

OBJECTIVE

To evaluate specific outcomes after addition of a Hospitalist-run, medical Preoperative clinic to the standard Anesthesia preoperative evaluation.

DESIGN, SETTING, PATIENTS: A pre/post retrospective, comparative review of outcomes of 5223 noncardiac surgical patients at a tertiary care Veterans Administration (VA) medical center.

RESULTS

Length of stay was reduced for inpatients with an American Society of Anesthesia (ASA) score of 3 or higher (P < 0.0001). There was a trend towards a reduction in same-day, medically avoidable surgical cancellations (8.5% vs 4.9%, P = 0.065). More perioperative beta blockers were used (P < 0.0001) and more stress tests were ordered (P = 0.012). Inpatient mortality rates were reduced (1.27% vs 0.36%, P = 0.0158).

CONCLUSION

A structured medical preoperative evaluation may benefit medically complex patients and improve perioperative processes and outcomes.

摘要

背景

结构化的医学术前评估可能会对复杂医学患者的围手术期过程产生积极影响。由于医院医生在住院内科和术后外科咨询方面的专业知识，他们在协助术前评估方面处于独特的地位。

目的

评估在标准麻醉术前评估中增加医院医生管理的医学术前诊所后的具体结果。

设计、地点、患者：在一家三级保健退伍军人管理局（VA）医疗中心对 5223 例非心脏手术患者的前后回顾性、比较性结果进行了回顾。

结果

ASA 评分为 3 或更高的住院患者的住院时间缩短（P < 0.0001）。当天取消可避免的手术的趋势有所减少（8.5% vs 4.9%，P = 0.065）。更多的围手术期β受体阻滞剂被使用（P < 0.0001），更多的应激试验被订购（P = 0.012）。住院患者死亡率降低（1.27% vs 0.36%，P = 0.0158）。