title: The role of a multidisciplinary pre-assessment clinic in reducing mortality after complex orthopaedic surgery.
abstract: BACKGROUND
  This paper describes an audit loop. The aim of this study was to audit the effect of a specialised preoperative anaesthetic assessment clinic after hip and knee arthroplasty and revision arthroplasty.
  
  
  METHODS
  We studied patients undergoing hip and knee surgery (arthroplasty and revision arthroplasty). We collected data concerning postoperative admissions to the high dependency unit (HDU), intensive care unit (ICU) and post-anaesthesia care unit (PACU) (planned and unplanned rates of admission, length of stay). We also noted mortality. In the first part of the study (April 2005 to March 2006) we studied 298 patients. All patients were assessed independently by an anaesthetist on the day of surgery. A multidisciplinary preoperative assessment clinic commenced in April 2006. After this date all patients were assessed preoperatively by a multidisciplinary anaesthetic lead team. In the second part of the study (May 2006 to April 2009) a further 1,147 arthroplasty patients were studied. Data were again collected regarding HDU, ICU, PACU and mortality, as noted above.
  
  
  RESULTS
  We found statistically significant (p = 0.001) reductions in the admissions to PACU (22% down to 10%) and in mortality (6.1% down to 1.2%) after the introduction of the pre-assessment clinic. There was also a statistically significant (p = 0.01) reduction in the HDU length of stay (2.1 days to 1.6 days), ICU unplanned admissions (1.3% to 0.4%) and the ICU length of stay (2.3 to 1.9 days). We estimated cost savings of nearly £50,000 in the second part of the study. This is based on the average decrease in HDU and ICU length of stay.
  
  
  CONCLUSIONS
  We recommend the use of a multidisciplinary pre-assessment clinic for complex orthopaedic surgery.
authors: Department of Orthopaedic Surgery, Princess Royal Hospital, Haywards Heath, West Sussex, UK. tamerkamal@yahoo.com
authors: T
authors: T
authors: Kamal
authors: R M
authors: RM
authors: Conway
authors: I
authors: I
authors: Littlejohn
authors: D
authors: D
authors: Ricketts
mesh_terms: D000776:Anesthesiology / Q000191:economics / Q000458:organization & administration; D019644:Arthroplasty, Replacement, Hip / Q000191:economics / Q000401:mortality*; D019645:Arthroplasty, Replacement, Knee / Q000191:economics / Q000401:mortality*; D017046:Cost Savings; D003422:Critical Care / Q000191:economics / Q000706:statistics & numerical data*; D004739:England; D006801:Humans; D007362:Intensive Care Units / Q000191:economics / Q000706:statistics & numerical data; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008485:Medical Audit; D010343:Patient Admission / Q000191:economics / Q000706:statistics & numerical data; D010348:Patient Care Team / Q000191:economics / Q000458:organization & administration*; D011183:Postoperative Complications / Q000401:mortality / Q000517:prevention & control / Q000628:therapy*; D011300:Preoperative Care / Q000191:economics / Q000379:methods* / Q000401:mortality