An assessment of the effectiveness of a pre-operative dental visit: an audit of the elective orthopaedic assessment clinic in relation to dental infection and joint arthroplasty

Abstract

This paper outlines the audit that was conducted to gauge the efficiency of the Elective Pre-operative Assessment Clinic in the Department of Orthopaedics, Kilcreene Orthopaedic Hospital, Kilkenny, Ireland. The study was conducted in 1999 when 380 patients were seen. Of these, 328 were on the waiting list for joint replacement and 52 for other elective procedures. We found 204 patients fit for surgery on their first pre-assessment visit. Of the 328 patients awaiting joint replacement, 48 had dental caries or infected gums, and 28 were diagnosed with minor infective foci elsewhere in the body. These 76 patients had their operations postponed until the infection resolved. One hundred and twenty-four patients had co-morbid medical conditions for which they were referred to allied medical specialities for further opinion and/or treatment. These patients had their operations after the medical conditions were stabilised or treated. The study in question has proved that the Elective Pre-operative Assessment Clinic acts as an intermediary between the outpatient department where the patient’s name is added to the waiting list and the operation theatre by determining patient’s fitness for surgery. This fact is of primary importance as it aids in preventing possible and sometimes last-minute cancellations, thereby attesting to the effectiveness and efficiency of the pre-assessment clinic. The study results have initiated a number of improvements to our Elective Pre-operative Assessment Clinic policies, such as the introduction of a checklist card for patients on the waiting list for joint replacements. This checklist includes blood and radiological investigations, medical co-morbid conditions and points to rule out infective foci in the body.