Introduction
Recently, increasing attention has been focused on efficient utilization
of healthcare services. Approximately 1.2 million outpatient and 350,000
inpatient surgeries were performed in Ontario in
2014/20151,2. Many patients undergo preoperative
screening in the form of laboratory or imaging investigations or
consultation with an anesthesiologist. This process of investigations
and consultation optimizes patients medically by identifying and
improving unstable conditions which might result in less perioperative
complications3.
As perioperative physicians, anesthesiologists provide significant
guidance to help determine which patients should undergo testing before
elective surgery. Since 2014, the Choosing Wisely Canada campaign has
endeavoured to help determine appropriate and necessary treatment by
medical specialty4. The Choosing Wisely Canada
recommendations for anesthesia include the avoidance of laboratory or
other cardiovascular testing for asymptomatic patients undergoing lower
risk surgeries. Several studies assessing the use of investigations
prior to low risk surgery showed that many patients continue to undergo
potentially unnecessary testing5,6.
There are currently no guidelines recommending appropriate use of
anesthesia consultation, and there appears to be significant practice
variation3,7. Wijeysundera et. al.8studied the use of anesthesia consultation in and found an increase in
preoperative anesthesia consultations from 19% in 1994 to 53% in 2003.
Patients who received anesthesia consultations had lower risks of
anxiety and day of surgery cancellations, as well as slightly shorter
hospital stays. Mortality risks were not different, and questions
regarding the cost-effectiveness of preoperative consultations were
raised. Overall, there appears to be a trend towards increasing use of
anesthesia consultation, even amongst patients undergoing low risk
surgeries, which potentially could result in inefficient use of health
care resources9. Presumably, higher risk patients
undergoing more invasive surgeries will get the most benefit from
preoperative consultation3,7. Similarly, there are no
specific guidelines for which patients can benefit from an internal
medicine consultation prior to surgery10.
In the current climate of limited health care resources, the authors
sought to obtain information regarding current and historical usage of
preoperative anesthesia consults. Herein, we carried out a
population-based study to evaluate the use of preoperative anesthesia
consultation services.