Efficacy of Anesthesia Clinic on Preoperative Evaluation, Preparation and Related Costs

Background: “Anesthesia Preoperative Evaluation Clinic” (A.P.E.C) is a center for pre-operative evaluation and preparation of the patients. The aim of this clinic is to obtain the essential data and history of the patient, optimize her/his condition in case of any co-existing disease before the operation and select the best method of anesthesia for the day of surgery. Materials and Methods: In an interventional quasi experimental study, pre and post operative para-clinical procedures which have been performed for patients having elective surgery were evaluated before and after establishing the APEC (1998 and 2001) in Labbafinejad Medical Center. After obtaining the demographic data including age, sex, ASA class and the type of surgery, two-hundred patients were placed in two groups. Information about the para-clinical results and requested medical consultation were recorded from the patients' files. All costs and expenses were recorded for both two groups. After obtaining the data including the percentage of para-clinical procedure, chest x-ray, ECG, ASA class, type of surgery and postponed operations before and after establishing the APEC, they were compared by chi-square test. Bed-day occupying factors and costs in both groups were compared by t-student test. Results: There were no significant differences between the 2 groups in terms of sex, ASA class and type of surgery. The number of admitted patients' in the year 1998 was about three times more than the year 2001 (2.11 days versus 0.55 day) (p=0.000) Chest x-ray was ordered for 18 %of the patients in the year 1998 group, whereas it decreased to about 0% (P=0.000) for the year 2001 group. The number of ordered medical laboratory exams in group 2 (2001) was significantly less than group 1(1998).Laboratory investigations were as follows: BUN (P=0.016), FBS (P=0.000), CBC (P=0.004), ESR (P=0.006), creatinine (P=0.000), urine analysis (P= 0.000), urine culture (P= 0.000), cholesterol (P=0.000), triglyceride (P=0.000).Medical consultations in group 2 were less than group 1 (chi-square=154.7, P=0.000).Comparison of the perioperative costs in all aspects showed a decrease after establishing the anesthesia clinic (P<0.000). Number of the operations cancelled by anesthesiologists had been decreased to 0 in group 2. Conclusion: Regarding our findings, establishment of the anesthesia clinic is essential and cost-effective. The study showed that anesthesia clinic prevents extra expenses and time consuming and unnecessary paraclinical procedures which will be ordered only in necessary and consulted cases. Date of operation will be defined after optimizing the patient's conditions to prevent unnecessary admission of patients, bed-occupying rate and postponed surgeries. It will save the precious time of physicians and hospital personnel and reduce the mortality and morbidity rate. (Tanaffos 2004; 3(12): 63-68)