Preoperative assessment clinics and case cancellations: a prospective study from a large medical center in China

BACKGROUND: Preoperative assessment clinics have great benefits in reducing surgical cancellations, saving hospital resources and improving patient satisfaction. However, previous studies did not focus on patients with comorbidities. With advancements in medicine and aging population, the number of elderly patients with multiple comorbidities is increasing. This study was designed to assess the effectiveness of a preoperative assessment clinic for patients with multiple comorbidities. METHODS: This prospective, observational study enrolled patients with multiple comorbidities from Nov 1, 2019 to Oct 31, 2020 in a tertiary teaching hospital in China. Patients either visited the preoperative assessment clinic before admission or received an anesthesia consultation after admission. The impact of clinic visits on operating room cancellations, length of hospital stay before surgery, length of hospital stay after surgery, major postoperative complications, incidence of postoperative intensive care unit (ICU) admission, readmission to any hospital within 30 days after surgeries and total in-hospital costs were analyzed. RESULTS: A total of 326 eligible cases were included. Eighty-seven of 108 cases who visited the clinic before admission were scheduled for selective surgeries. In all, 218 patients received an anesthesia consultation after admission. The cancellation rate in the inpatient group was 7.80%, while no surgeries were cancelled in preclinic group (P=0.016). A preoperative assessment clinic visit statistically decreased the length of in-hospital stays before surgery from 93.02 to 76.11 h (P=0.010). After propensity score matching, significant differences in operating room cancellations (0 vs. 6.48%; P=0.015) and length of stay before surgery (76.11 vs. 92.22 h; P=0.038) persisted between two groups. No significant differences between the two groups were found in terms of prognosis, including major postoperative complications, incidence of postoperative ICU admissions, and readmissions to any hospital within 30 days (P>0.05). CONCLUSIONS: Among patients with comorbidities undergoing major surgeries, a preoperative assessment clinic visit was more efficient than an anesthesia consultation after admission. These findings may provide impetus for the opening of preoperative assessment clinics for critical patients in China.