Introduction
Recently, increasing attention has been focused on efficient utilization of healthcare services. Approximately 1.2 million outpatient and 350,000 inpatient surgeries were performed in Ontario in 2014/20151,2. Many patients undergo preoperative screening in the form of laboratory or imaging investigations or consultation with an anesthesiologist. This process of investigations and consultation optimizes patients medically by identifying and improving unstable conditions which might result in less perioperative complications3.
As perioperative physicians, anesthesiologists provide significant guidance to help determine which patients should undergo testing before elective surgery. Since 2014, the Choosing Wisely Canada campaign has endeavoured to help determine appropriate and necessary treatment by medical specialty4. The Choosing Wisely Canada recommendations for anesthesia include the avoidance of laboratory or other cardiovascular testing for asymptomatic patients undergoing lower risk surgeries. Several studies assessing the use of investigations prior to low risk surgery showed that many patients continue to undergo potentially unnecessary testing5,6.
There are currently no guidelines recommending appropriate use of anesthesia consultation, and there appears to be significant practice variation3,7. Wijeysundera et. al.8studied the use of anesthesia consultation in and found an increase in preoperative anesthesia consultations from 19% in 1994 to 53% in 2003. Patients who received anesthesia consultations had lower risks of anxiety and day of surgery cancellations, as well as slightly shorter hospital stays. Mortality risks were not different, and questions regarding the cost-effectiveness of preoperative consultations were raised. Overall, there appears to be a trend towards increasing use of anesthesia consultation, even amongst patients undergoing low risk surgeries, which potentially could result in inefficient use of health care resources9. Presumably, higher risk patients undergoing more invasive surgeries will get the most benefit from preoperative consultation3,7. Similarly, there are no specific guidelines for which patients can benefit from an internal medicine consultation prior to surgery10.
In the current climate of limited health care resources, the authors sought to obtain information regarding current and historical usage of preoperative anesthesia consults. Herein, we carried out a population-based study to evaluate the use of preoperative anesthesia consultation services.