[Survey on the preoperative evaluation in Catalonian surgical centers. II. What is the attitude and opinion of the professionals involved?]

OBJECTIVE

Previous studies have provided evidence of the existence of differences in preoperative assessment practices and have questioned the usefulness of generalized testing for all patients. The objective of this study was to determine the attitudes and opinions of anesthesiologists and surgeons about their application of preoperative assessment procedures and their knowledge of the scientific principles underlying their practice.

SUBJECTS AND METHODS

A questionnaire was mailed to 227 specialists in anesthesiology and postoperative intensive care, general and gastrointestinal surgery, orthopedic surgery and traumatology of all hospitals in Catalonia (Spain) with active operating theaters.

RESULTS

The overall response rate was 61% of the surveyed population, with 86% of the Catalan hospitals represented. The medical literature supports the routine performance of a chest x-ray and an ECG in the opinion of 17 and 26% of the respondents, respectively. Those two procedures are always ordered by 43 and 37%, respectively, even if they believe that the medical literature does not support generalized application. Legal protection was given as the reason for routine ordering of preoperative tests in asymptomatic patients, and 89% believed that a protocol for selective preoperative assessment procedures would improve efficiency.

CONCLUSIONS

This study reveals a discrepancy between the opinions of professionals involved in preoperative assessment and their real practice in Catalan hospitals, probably influenced by perceived need for legal protection.

[Survey on the preoperative evaluation in Catalonian surgical centers. I. What is the preoperative routine?]

OBJECTIVE

To describe the preoperative assessment procedures currently used in hospitals in Catalonia (Spain).

SUBJECTS AND METHODS

The study population consisted of all heads of departments of anesthesiology, general and gastrointestinal surgery, orthopedic surgery and traumatology of hospitals and clinics in Catalonia with active operating theaters. Information was obtained by self-administered questionnaire prepared by an interdisciplinary team.

RESULTS

Of the 227 questionnaires sent, 139 (61%) were answered and returned. A preoperative assessment visit was programmed according to 112 (81%) of the respondents and 123 (89.8%) reported following a protocol that included ordering preoperative tests. The same tests were ordered for all patients by 25% of the respondents. A chest film and an ECG were always ordered according to 61 and 65%, respectively, and always when the patient was over a certain age according to 36 and 32%, respectively. Coagulation and blood sugar tests and a complete blood workup were always ordered according to 94%, 95% and 89%, respectively. Tests were considered valid for less than six months by most.

CONCLUSIONS

This survey provides evidence of widespread use of preoperative assessment, although application falls short of including all scheduled patients. According to these results, selective protocols for ordering complementary preoperative tests are rarely applied.