Guidelines for preoperative assessment: impact on clinical practice and costs.
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.
Ferrando
Alberto
A
ASO San Giovanni Battista, Università di Torino and CPO Piemonte, Unit of Cancer Epidemiology, Italy. aferrando@molinette.piemonte.it
Ivaldi
Cristiana
C
Buttiglieri
Alessandro
A
Pagano
Eva
E
Bonetto
Chiara
C
Arione
Roberto
R
Scaglione
Luca
L
Gelormino
Elena
E
Merletti
Franco
F
Ciccone
Giovannino
G
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*