France F H, Lefebvre C
Département de Médecine Interne, Service de Médecine Interne Générale, Cliniques Universitaires St-Luc, Bruxelles.
Acta Clin Belg. 1997;52(5):275-86. doi: 10.1080/17843286.1997.11718589.
Preoperative medical evaluation is needed to assess individual patients risks of perioperative morbidity and mortality. The content of the preoperative examination remains the object of discussion. Although a well documented preoperative assessment of a patient's health status might allow to optimise his condition before surgery and to plan the most appropriate perioperative management, leading to an improvement of perioperative outcome as well as a reduction in costs, data to support this claim are still most often indirect. A large number of patients remain asymptomatic, with normal tests, which raises questions about the appropriateness to request a battery of tests on every candidate to surgery. Patients risks should be assessed mainly by history and physical examination, which might reduce drastically preoperative indication of laboratory tests: age, operation site, preoperative diseases and emergent surgery are important factors to consider. A risk estimate is presented, as well as recommendations for a preoperative health assessment, by categories of patients, following a screening pathway. Costs have been estimated in various alternatives. They have been evaluated to be above 2 billion BEF per year in Belgium for 563,485 surgical cases, and could most likely be reduced by about 60% in a near future.
术前医学评估对于评估个体患者围手术期发病和死亡风险是必要的。术前检查的内容仍是讨论的对象。尽管对患者健康状况进行充分记录的术前评估可能有助于在手术前优化其状况并规划最合适的围手术期管理，从而改善围手术期结果并降低成本，但支持这一说法的数据往往仍然是间接的。大量患者无症状且检查结果正常，这引发了对于对每位手术候选人进行一系列检查是否合适的质疑。患者风险应主要通过病史和体格检查进行评估，这可能会大幅减少术前实验室检查的指征：年龄、手术部位、术前疾病和急诊手术是需要考虑的重要因素。本文按照筛查路径，针对不同类别的患者给出了风险评估以及术前健康评估建议。对各种替代方案的成本进行了估算。在比利时，每年563,485例手术病例的成本估计超过20亿比利时法郎，并且在不久的将来很可能会降低约60%。
