You might not need a consultation before routine surgery: study

A new study that looked at more than 300,000 patients suggests that when it comes to medical outcomes, it may not be necessary to make an appointment with a specialist before the routinely considered surgery.

The study was published Monday in a peer-reviewed journal JAMA Internal Medicine We found that receiving a preoperative consultation was not associated with better outcomes after surgery.

The idea behind preoperative consultations with specialists such as cardiologists, endocrinologists, and nephrologists is to consider health issues that may cause complications during surgery. Canadian surgeons refer more than 40,000 patients a year to these consultations in preparation for surgery, but debate continues as to whether they are entirely necessary.

Dr. Weiwei Beckerleg, General Physician at Ottawa Hospital and Assistant Professor at the University of Ottawa, said: said in a press release. “Most patients I see already cover the same position as an anesthesiologist. I’ve had patients ask me, ‘Why am I here?'”

In this new study, researchers looked at patient data from 2005 to 2018 in Ontario, focusing on surgical outcomes and whether they received preoperative medical consultations.

If these consultations led to improved surgical outcomes, it would be an argument for their benefit.

Data from approximately 359,000 patients in this study showed that 0.7% of patients who did not seek medical attention died within 30 days after surgery, whereas 0.9% of patients who had preoperative medical consultation died after surgery. Died within a month.

To get the widest field of view, the researchers started with a sample of about 530,000 patients.

Eligible patients were all 40 years of age or older and underwent moderate-to-high-risk non-cardiac surgery, such as hip or knee replacement, gastrointestinal surgery, or surgery to remove cancer or parts of an organ. received.

Approximately 35% of these patients had a preoperative medical consultation within 4 months after surgery. The researchers then matched these 186,000 of her patients to a set of 179,000 of her patients who were similar in health, age, sex, type of surgery, and had no preoperative medical consultation. bottom.

Comparing the two groups, those who attended had a slightly higher change in mortality within 30 days after surgery.

Rates of inpatient stroke, hospital ventilator, and emergency department visits within 30 days after surgery were also slightly higher in the consultation group. Consultation groups were also more likely to be prescribed beta-blockers, and although these drugs are usually very beneficial, some studies have shown that newer prescriptions for patients just prior to surgery reduce the likelihood of stroke and death. Researchers have expressed concern because it is associated with increasing

It’s unclear why preoperative consultation was associated with slightly higher mortality, but it could be a matter of timing, the researchers say.

“The goal of preoperative medical consultations is to help patients become healthy enough for surgery without delaying emergency surgery. Daniel Maaizak, Ph.D., chair of perioperative care and senior author of the study, said in a release.

The researchers noted that although the mortality difference was statistically significant, the absolute difference was small. A more important detail is the fact that no clear advantage was found in receiving preoperative consultation regarding surgical outcomes, and researchers believe that guidelines and policies regarding these may need adjustment. It suggests that

According to the release, 10-40% of elective surgery patients in Canada now receive a preoperative medical consultation.

The greatest predictor of whether patients were referred for preoperative consultation was which hospital they were seen at, not the type of surgery or overall health.

Larger hospitals affiliated with medical colleges were more likely to offer preoperative consultations, as they tend to have more staff and perform higher-risk surgeries.

The study was conducted by researchers at the Ottawa Hospital, according to the release. At the Ottawa hospital, visits are only made to address specific issues, not to authorize a patient for surgery.

Going forward, the researchers recommend that older patients prioritize a preoperative consultation that includes an expert evaluation by a geriatrician. This is because these specific consultations have been shown in previous studies to improve survival.

In the future, further research could identify when preoperative consultation is truly needed and integrate data on how patient-driven decision-making and patient satisfaction with the outcome influence consultation questions. I expect

“We’re not saying preoperative medical consultations should be abolished,” Beckerleg said. “However, we are not convinced that they will always make a difference based on how they currently operate. Further research is needed to find out which patients benefit most from these consultations. In the meantime, we hope our findings will inspire medical institutions to optimize preoperative care.”

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