title: Perioperative processes and outcomes after implementation of a hospitalist-run preoperative clinic.
abstract: BACKGROUND
  A structured, medical preoperative evaluation may positively impact the perioperative course of medically complex patients. Hospitalists are in a unique position to assist in preoperative evaluations, given their expertise with inpatient medicine and postoperative surgical consultation.
  
  
  OBJECTIVE
  To evaluate specific outcomes after addition of a Hospitalist-run, medical Preoperative clinic to the standard Anesthesia preoperative evaluation.
  
  
  METHODS
  A pre/post retrospective, comparative review of outcomes of 5223 noncardiac surgical patients at a tertiary care Veterans Administration (VA) medical center.
  
  
  RESULTS
  Length of stay was reduced for inpatients with an American Society of Anesthesia (ASA) score of 3 or higher (P < 0.0001). There was a trend towards a reduction in same-day, medically avoidable surgical cancellations (8.5% vs 4.9%, P = 0.065). More perioperative beta blockers were used (P < 0.0001) and more stress tests were ordered (P = 0.012). Inpatient mortality rates were reduced (1.27% vs 0.36%, P = 0.0158).
  
  
  CONCLUSIONS
  A structured medical preoperative evaluation may benefit medically complex patients and improve perioperative processes and outcomes.
authors.affiliation: Department of Medicine, Hospitalist Division, VA Greater Los Angeles Healthcare System, David Geffen School of Medicine at UCLA, Los Angeles, CA 90073, USA. Sondra.vazirani@va.gov
authors.forename: Sondra
authors.initials: S
authors.lastname: Vazirani
authors.forename: Azadeh
authors.initials: A
authors.lastname: Lankarani-Fard
authors.forename: Li-Jung
authors.initials: LJ
authors.lastname: Liang
authors.forename: Matthias
authors.initials: M
authors.lastname: Stelzner
authors.forename: Steven M
authors.initials: SM
authors.lastname: Asch
mesh_terms: D000368:Aged; D000758:Anesthesia / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D020445:Hospitalists / Q000458:organization & administration*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010044:Outpatient Clinics, Hospital / Q000458:organization & administration* / Q000706:statistics & numerical data; D019990:Perioperative Care / Q000706:statistics & numerical data; D011300:Preoperative Care / Q000379:methods*; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D062606:Tertiary Care Centers / Q000458:organization & administration* / Q000706:statistics & numerical data; D014481:United States; D014493:United States Department of Veterans Affairs