title: Patterns of preoperative consultation and surgical specialty in an integrated healthcare system.
abstract: BACKGROUND
  Many patients scheduled for elective surgery are referred for a preoperative medical consultation. Only limited data are available on factors associated with preoperative consultations. The authors hypothesized that surgical specialty contributes to variation in referrals for preoperative consultations.
  
  
  METHODS
  This is a cohort study using data from Group Health Cooperative, an integrated healthcare system. The authors included 13,673 patients undergoing a variety of common procedures-primarily low-risk surgeries-representing six surgical specialties, in 2005-2006. The authors identified consultations by family physicians, general internists, pulmonologists, or cardiologists in the 42 days preceding surgery. Multivariable logistic regression was used to estimate the association between surgical specialty and consultation, adjusting for potential confounders including the revised cardiac risk index, age, gender, Deyo comorbidity index, number of prescription medications, and 11 medication classes.
  
  
  RESULTS
  The authors found that 3,063 (22%) of all patients had preoperative consultations, with significant variation by surgical specialty. Patients having ophthalmologic, orthopedic, or urologic surgery were more likely to have consultations compared with those having general surgery-adjusted odds ratios (95% CI) of 3.8 (3.3-4.2), 1.5 (1.3-1.7), and 2.3 (1.8-2.8), respectively. Preoperative consultations were more common in patients with lower revised cardiac risk scores.
  
  
  CONCLUSIONS
  There is substantial practice variation among surgical specialties with regard to the use of preoperative consultations in this integrated healthcare system. Given the large number of consultations provided for patients with low cardiac risk and for patients presenting for low-risk surgeries, their indications, the financial burden, and cost-effectiveness of consultations deserve further study.
authors.affiliation: Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA. sthilen@uw.edu
authors.forename: Stephan R
authors.initials: SR
authors.lastname: Thilen
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Bryson
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Reid
authors.forename: Duminda N
authors.initials: DN
authors.lastname: Wijeysundera
authors.forename: Edward M
authors.initials: EM
authors.lastname: Weaver
authors.forename: Miriam M
authors.initials: MM
authors.lastname: Treggiari
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D015897:Comorbidity; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010818:Practice Patterns, Physicians'; D057234:Preoperative Period; D055553:Prescription Drugs; D012017:Referral and Consultation; D012306:Risk; D013043:Specialties, Surgical / Q000458:organization & administration*; D013514:Surgical Procedures, Operative / Q000009:adverse effects / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D055553:Prescription Drugs