From the Departments of Anesthesiology.
Population Health, Duke University School of Medicine, Durham, North Carolina.
Anesth Analg. 2020 Apr;130(4):811-819. doi: 10.1213/ANE.0000000000004571.
Preoperative assessment typically equates to evaluating and accepting the presenting condition of the patient (unless extreme) and commonly occurs only a few days before the planned surgery. While this timing enables a preoperative history and examination and mitigates unexpected findings on the day of surgery that may delay throughput, it does not allow for meaningful preoperative management of modifiable medical conditions. Evidence is limited regarding how best to balance efforts to mitigate modifiable risk factors versus the timing of surgery. Furthermore, while the concept of preoperative risk modification is not novel, evidence is lacking for successful and sustained implementation of such an interdisciplinary, collaborative program. A better understanding of perioperative care coordination and, specifically, implementing a preoperative preparation process can enhance the value of surgery and surgical population health. In this article, we describe the implementation of a collaborative preoperative clinic with the primary goal of improving patient outcomes.
术前评估通常等同于评估和接受患者的现有状况（除非情况极端），通常仅在计划手术前几天进行。虽然这种时间安排可以进行术前病史和检查，并减轻手术当天可能导致手术流程延迟的意外发现，但它并不允许对可改变的医疗状况进行有意义的术前管理。关于如何最好地平衡减轻可改变风险因素的努力与手术时间的关系，证据有限。此外，尽管术前风险修正的概念并不新颖，但缺乏成功和持续实施这种跨学科、协作计划的证据。更好地了解围手术期护理协调，特别是实施术前准备过程，可以提高手术和手术人群健康的价值。在本文中，我们描述了协作术前诊所的实施，其主要目标是改善患者的预后。
