Preoperative and postoperative medical evaluation of surgical patients.

The purpose of this study was to analyze the cost-benefit of routine preoperative and postoperative medical evaluation of surgical patients. We analyzed the records of 70 patients who underwent selected common general and vascular surgical procedures according to their surgical risk, and assessed the potential change in outcome from medical evaluation. Our findings suggest that for low-risk surgical patients undergoing these procedures, medical evaluation is unlikely to affect outcome and, thus, may be unnecessary. There appears to be some benefit, however, for medium-risk surgical patients. Although we do not suggest the abolishment of all preoperative and postoperative medical evaluations, we do recommend the much more selective use of this valuable resource. Our data suggest that significant improvement in efficiency for many hospitals may be possible by omitting routine preoperative and postoperative medical evaluation for certain patients and by obtaining medical evaluation only in selected medium and higher risk surgical patients (ASA class 3 and above).