Outpatient preoperative evaluation clinic can lead to a rapid shift from inpatient to outpatient surgery: a retrospective review of perioperative setting and outcome.
OBJECTIVE
To report the rapid shift from inpatient to outpatient surgery that occurred after opening an outpatient preoperative evaluation clinic and the perioperative complications and mortality rates before and after this intervention.


METHODS
Monthly variations of total volume of procedures and percentages of outpatient procedures were analyzed retrospectively using control charts over two consecutive 10-month periods before and after the intervention. For each type of procedure (inpatient vs. outpatient), the perioperative complications and 30-day mortality rates were compared between periods.


METHODS
The Veterans Affairs Palo Alto Health Care System, Palo Alto, California.


METHODS
Patients who underwent 3,159 inpatient or outpatient procedures in the main operating room suite during the control period were compared with patients who underwent 3,190 procedures in the same operating room suite during the intervention period.


METHODS
The establishment of an outpatient preoperative evaluation clinic.


RESULTS
For each period, the total monthly surgical volume (inpatient and outpatient), perioperative complications, deaths within 30 days of surgery, and the number of procedures performed on patients classified as ASA physical status III, IV, or V were analyzed. The monthly total number of procedures was stable over both periods, but the monthly percentage of outpatient procedures departed from its baseline immediately after establishing the clinic (control period: 24.7%; study period: 45.4%; p << 0.0001). Finally, the perioperative complication rate did not change for outpatient procedures but increased for inpatient procedures (control period: 2.31%; study period: 3.50%; p < 0.05). The 30-day mortality rate remained unchanged for inpatient and outpatient procedures.


CONCLUSIONS
Establishing an outpatient preoperative evaluation clinic can lead to a rapid shift from inpatient to outpatient surgery at a government funded hospital without a concomitant increase in perioperative morbidity or mortality.
Department of Anesthesia, Stanford University School of Medicine, CA, USA.
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JB
Pollard
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Garnerin
D000368:Aged; D000553:Ambulatory Care / Q000379:methods*; D005069:Evaluation Studies as Topic; D006801:Humans; D007297:Inpatients; D007430:Intraoperative Care / Q000379:methods*; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D011300:Preoperative Care / Q000379:methods*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome