title: Guidelines for preoperative assessment: impact on clinical practice and costs.
abstract: OBJECTIVE
  To describe preoperative evaluation in the San Giovanni Battista Hospital in Turin and to forecast the economic impact when preoperative assessment guidelines are implemented.
  
  
  METHODS
  We enrolled, in a month, 702 consecutive patients, excluding cardiac, thoracic, neuro- and vascular surgery, as well as emergency operations. Preoperative assessment data were collected individually, followed by simulating various applications of guidelines based on: (i) preoperative tests relying on full medical history and physical examination to discriminate preoperative risk patients; (ii) organization of a preoperative evaluation unit and tests before patient hospitalization.
  
  
  METHODS
  Mean number of tests prescribed, preoperative assessment cost per patient.
  
  
  RESULTS
  The application of preoperative guidelines would decrease the mean number of tests prescribed from 20 laboratory and 1.9 instrumental to, respectively, 3 and 1.4 per patient. Tests deemed inappropriate by guidelines did not add any relevant clinical information to our study. Economic analysis estimates a reduction of 63% in cost per patient for preoperative tests by introducing guideline criteria (from 69 euros to 26 euros). As regards the cost per patient for preoperative evaluation and hospital stay (115 euros considering only variable costs, 580 euros including all costs), the application of the guidelines would reduce costs by 41-52% according to different cost evaluation approaches for hospital stay.
  
  
  CONCLUSIONS
  Preoperative guidelines fully introduced in practice could notably increase efficiency without affecting the quality of care.
authors.affiliation: ASO San Giovanni Battista, Università di Torino and CPO Piemonte, Unit of Cancer Epidemiology, Italy. aferrando@molinette.piemonte.it
authors.forename: Alberto
authors.initials: A
authors.lastname: Ferrando
authors.forename: Cristiana
authors.initials: C
authors.lastname: Ivaldi
authors.forename: Alessandro
authors.initials: A
authors.lastname: Buttiglieri
authors.forename: Eva
authors.initials: E
authors.lastname: Pagano
authors.forename: Chiara
authors.initials: C
authors.lastname: Bonetto
authors.forename: Roberto
authors.initials: R
authors.lastname: Arione
authors.forename: Luca
authors.initials: L
authors.lastname: Scaglione
authors.forename: Elena
authors.initials: E
authors.lastname: Gelormino
authors.forename: Franco
authors.initials: F
authors.lastname: Merletti
authors.forename: Giovannino
authors.initials: G
authors.lastname: Ciccone
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019411:Clinical Laboratory Techniques / Q000191:economics* / Q000592:standards*; D005260:Female; D017721:Hospital Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011300:Preoperative Care / Q000191:economics* / Q000592:standards*