Pre-operative medical consultation rates vary widely from hospital to hospital, and it's not entirely clear what determines which patients are examined and which aren't, according to a Canadian study.
For a study published in the January issue of the journal Anesthesiology, researchers reviewed database records of 204,819 patients over 40 years of age who underwent major, elective, non-cardiac surgery in 79 of Ontario's hospitals between April 2004 and February 2009. They noted that 38% of the patients were referred to an internal medicine specialist for examination and testing beyond the basic history and physical.
But the rate of these referrals varied widely between facilities. At some, 90% of patients received such consultations, while only 1% were examined at others. Is it possible that some patients are subjected to unnecessary tests, while others don't get the examinations they need? Researchers think so. The referrals could not be correlated to the type of surgery, the facility's case volume or whether the facility was a teaching hospital. In fact, only 5.9% of the consultations were due to a patient's health or a surgery's risks.
"That suggests the forces driving this have little to do with how sick the patient is," says study co-author Duminda N. Wijeysundera, MD, PhD, FRCPC, a research scientist at St. Michael's Hospital in Toronto and an anesthesiologist at Toronto General Hospital-University Health Network. "Further research is needed to better understand the basis for this inter-hospital variation and to determine which patients benefit most from pre-operative consultation."
David Bernard
