Ziolkowski Natalia, Milkovich John, Ahmad Jamil, Benakopoulos Elizabeth, Lista Frank, Chbat Tarek, Austin Ryan E
Aesthet Surg J. 2025 Aug 18;45(9):957-964. doi: 10.1093/asj/sjaf054.
Limited resources combined with an increasingly "cost-conscious" approach to healthcare has resulted in a reduction of those preoperative investigations deemed unnecessary. Although this approach may work in the hospital setting where ancillary services and emergency support are readily available, it may actually be impacting patient safety in the ambulatory surgery center (ASC) setting.
The purpose of this study was to determine the prevalence of abnormal results arising from routine preoperative workup amongst patients undergoing aesthetic surgery in the outpatient ASC setting. The goal was to examine whether abnormal results led to alterations in care that otherwise would not have been made had the workup not been performed, and to outline patient factors associated with alterations in care.
A retrospective chart review was performed of 2596 consecutive patients who underwent aesthetic surgery over a 40-month period at a single Canadian ASC. Data collected included patient demographics, procedural characteristics, and outcomes. Preoperative workups were categorized as either required (for patients with positive findings on medical history and/or physical examination) or supplementary (for otherwise healthy patients).
A total of 2581 patients met the inclusion criteria for the study. The majority of patients were female (91.2%) and had undergone breast surgery (60.3%). All patients underwent independent preoperative medical history and physical examination with bloodwork/screening. In total, 838 patients (32.5%) had abnormal bloodwork results, while 240 (9.3%) had abnormal electrocardiograms. These abnormal tests resulted in alterations in care for 242 patients (9.4% of total patients with 293 unique care alterations). Alterations in care included pharmacotherapy (n = 104, 35.5%), additional investigations (n = 78, 26.6%), specialist consultations (n = 67, 22.9%), and postponement of surgery (n = 44, 15.0%). Demographic variables associated with alterations in care included: age ≥50 years (P < .00001), female sex (P = .0235), higher ASA class (P < .00001), and pre-existing medical comorbidities (P < .00001).
Preoperative workups are an important factor for improving patient safety in outpatient aesthetic surgery. These investigations can uncover occult issues that may increase the risk of complications in the ASC setting.
资源有限，加上医疗保健领域日益“注重成本”的做法，导致那些被认为不必要的术前检查减少。虽然这种做法在辅助服务和紧急支持随时可用的医院环境中可能有效，但实际上可能会影响门诊手术中心（ASC）环境中的患者安全。
本研究的目的是确定在门诊ASC环境中接受美容手术的患者常规术前检查产生异常结果的发生率。目标是检查异常结果是否导致护理变更，如果未进行检查，这些变更原本不会发生，并概述与护理变更相关的患者因素。
对在加拿大一家ASC连续40个月接受美容手术的2596例患者进行回顾性病历审查。收集的数据包括患者人口统计学、手术特征和结果。术前检查分为必需检查（针对病史和/或体格检查有阳性发现的患者）或补充检查（针对其他方面健康的患者）。
共有2581例患者符合研究纳入标准。大多数患者为女性（91.2%），接受过乳房手术（60.3%）。所有患者均接受了独立的术前病史和体格检查以及血液检查/筛查。总共838例患者（32.5%）血液检查结果异常，240例（9.3%）心电图异常。这些异常检查导致242例患者（占总患者数的9.4%，有293项独特的护理变更）的护理发生变更。护理变更包括药物治疗（n = 104，35.5%）、额外检查（n = 78，26.6%）、专科会诊（n = 67，22.9%）和手术延期（n = 44，15.0%）。与护理变更相关的人口统计学变量包括：年龄≥50岁（P <.00001）、女性（P =.0235）、ASA分级较高（P <.00001）和既往有医疗合并症（P <.00001）。
术前检查是提高门诊美容手术患者安全的重要因素。这些检查可以发现可能增加ASC环境中并发症风险的隐匿问题。
