Characteristics and effectiveness of preoperative consultations in a tertiary hospital

provided the original work is properly cited. CC As the population is aging and chronically-ill patients have increased, the need of consultation has also increased [1]. And, as medical specialties become even more specialized, the dependency on consultation in patient evaluation and management has elevated. Appropriate use of consultation services might result in better prognosis for postoperative patients. However, overutilization of consultation services can cause unnecessary increase in hospitalization periods, efforts, and resources. The purpose of this study is to evaluate the current status of preoperative consultations and its effectiveness. The medical records of patients who had taken the elective operations for general anesthesia, regional anesthesia and nerve block in March and April of 2010 at the tertiary hospital’s operating theater were being reviewed. The number of consultations, consulted departments, the consulting surgical departments, and number of operations conducted by each surgical department were being analyzed. The total number of consultations in the hospital during the study period was retrieved, and consultation proportion was calculated by number of consultations per number of operations. The number of requested consultations was classified according to the specialties consulted. The purpose of consultation was specified as ‘for risk evaluations’, ‘for perioperative management’, or for both. The consultation responses was classified into ‘suggesting to proceed the operation with attention’, ‘suggesting to proceed with the operation after additional work-ups’ and ‘suggesting to delay the operation’. As a result, in March and April, 2010, the total number of anesthesia, which includes general or regional anesthesia and nerve block, was 1245. Of all the operations, 453 patients (36.4%) had been requested for consultation, and the total number of consultations taken was 663. More preoperative consultations had been conducted by orthopedic surgery, followed by otolaryngology, urosurgery, general surgery. For cases of specialty consultation, cardiology (271 cases, 40.9%) is the leading specialty followed by pulmonology (129 cases, 19.5%), endocrinology (86 cases, 13.0%), neurology (66 cases, 9.9%). The number of consultations for anesthesiology is only 14 (2.1%) (Table 1). The aim of consultation was mainly for perioperative managements (54.6%) and preoperative risk evaluations (37.0%). As a result of consultation, additional evaluation was recommended for 13.6%, and delaying operation was recommended for 1.1% (Table 1). This result shows that about one third of patients who were scheduled for surgery had been requested for preoperative con-