Department of Surgery, Penn Medicine, 3400 Spruce Street, 4 Silverstein, Philadelphia, PA, 19104, USA.
Department of Surgery, Penn Medicine, 3400 Spruce Street, 4 Silverstein, Philadelphia, PA, 19104, USA; University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
Am J Surg. 2023 Sep;226(3):324-329. doi: 10.1016/j.amjsurg.2023.03.027. Epub 2023 Mar 29.
United States regulations require a history and physical (H&P) ≤30 days before planned procedures. We evaluated the impact of H&P update visits in colorectal surgery.
Preoperative H&P update visits conducted in colorectal clinics at our institution during 2019 were identified. Two independent reviewers assessed whether update visits identified interval changes to history, exam, or operative plan. Secondary outcomes included visit times, estimated travel times and distances.
For 132 visits, interval changes were identified in 39% of histories, but only 4.2% of exams and 6.8% of operative plans. When plans changed, visit goals could have been accomplished via telehealth in 77.8%. Median clinic and round-trip driving time were 61.5 and 62.2 min, respectively.
H&P update visits conducted to satisfy the 30-day regulation rarely result in clinically relevant changes yet impose time and travel burdens on patients. Regulations should be revised to provide flexibility in H&P update modalities.
美国法规要求计划手术前 30 天内进行病史和体检（H&P）。我们评估了 H&P 更新访视在结直肠手术中的影响。
在我院结直肠门诊进行的 2019 年术前 H&P 更新访视被确定。两名独立的评审员评估了更新访视是否确定了病史、检查或手术计划的间隔变化。次要结果包括访视时间、估计的旅行时间和距离。
在 132 次访视中，39%的病史发生了间隔变化，但只有 4.2%的检查和 6.8%的手术计划发生了变化。当计划发生变化时，77.8%的访视目标可以通过远程医疗来实现。诊所和往返驾驶的中位数时间分别为 61.5 和 62.2 分钟。
为满足 30 天的规定而进行的 H&P 更新访视很少导致临床相关的变化，但给患者带来了时间和旅行负担。应修订法规，为 H&P 更新方式提供灵活性。
