title: Cost-effectiveness of preoperative examinations.
abstract: Preoperative medical evaluation is needed to assess individual patients risks of perioperative morbidity and mortality. The content of the preoperative examination remains the object of discussion. Although a well documented preoperative assessment of a patient's health status might allow to optimise his condition before surgery and to plan the most appropriate perioperative management, leading to an improvement of perioperative outcome as well as a reduction in costs, data to support this claim are still most often indirect. A large number of patients remain asymptomatic, with normal tests, which raises questions about the appropriateness to request a battery of tests on every candidate to surgery. Patients risks should be assessed mainly by history and physical examination, which might reduce drastically preoperative indication of laboratory tests: age, operation site, preoperative diseases and emergent surgery are important factors to consider. A risk estimate is presented, as well as recommendations for a preoperative health assessment, by categories of patients, following a screening pathway. Costs have been estimated in various alternatives. They have been evaluated to be above 2 billion BEF per year in Belgium for 563,485 surgical cases, and could most likely be reduced by about 60% in a near future.
authors.affiliation: Département de Médecine Interne, Service de Médecine Interne Générale, Cliniques Universitaires St-Luc, Bruxelles.
authors.forename: F H
authors.initials: FH
authors.lastname: France
authors.forename: C
authors.initials: C
authors.lastname: Lefebvre
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D003955:Diagnostic Tests, Routine / Q000191:economics*; D006801:Humans; D008487:Medical History Taking; D008875:Middle Aged; D010808:Physical Examination; D017410:Practice Guidelines as Topic; D011300:Preoperative Care / Q000191:economics*; D018570:Risk Assessment; D013514:Surgical Procedures, Operative / Q000401:mortality