MP86-12 ROUTINE REFERRAL FOR PREOPERATIVE MEDICAL EVALUATION MAY BE SAFELY OMITTED AMONG PATIENTS UNDERGOING RADICAL PROSTATECTOMY

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Value of Care: Cost & Outcomes Measures II1 Apr 2018MP86-12 ROUTINE REFERRAL FOR PREOPERATIVE MEDICAL EVALUATION MAY BE SAFELY OMITTED AMONG PATIENTS UNDERGOING RADICAL PROSTATECTOMY Nima Almassi, Michelle Ponziano, Howard Goldman, and Venkatesh Krishnamurthi Nima AlmassiNima Almassi More articles by this author , Michelle PonzianoMichelle Ponziano More articles by this author , Howard GoldmanHoward Goldman More articles by this author , and Venkatesh KrishnamurthiVenkatesh Krishnamurthi More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2892AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Surgical patient are frequently referred for preoperative medical evaluation (PME) for surgical clearance and medical optimization without evidence of benefit to such evaluations. We hypothesized that the addition of PME to the standard preoperative urologic and anesthesiology evaluations rarely affects a patient's perioperative management and that perioperative outcomes are similar between patients who do and do not undergo PME. To test this hypothesis, we examined the frequency with which PMEs affect the perioperative management of patients undergoing radical prostatectomy (RP) and compared outcomes between patients who did and did not undergo PME. METHODS All patients who underwent RP at our tertiary referral center in 2014 were identified. All patients undergo preoperative urologic and anesthesiology evaluation. Patients who additionally underwent PME were identified. PMEs leading to additional diagnostic testing or perioperative management recommendations were classified as impacting perioperative patient management. Perioperative outcomes were compared between patients who did and did not undergo PME. RESULTS Three hundred eighty-three patients met inclusion criteria, 233 (61%) of whom underwent urologic and anesthesiology evaluation alone with the remaining 150 (39%) additionally undergoing PME. Only one of the 150 patients referred for PME was referred for a specific clinical indication, evaluation of stable angina. The remainder were referred for routine surgical clearance or optimization. Three of 150 PMEs (2%) affected perioperative management, with three patients undergoing additional diagnostic cardiovascular testing, one of whom was also prescribed an additional antihypertensive medication. Perioperative outcomes were similar between patients who did and did not undergo PME, with similar rates of any 30-day complication (16.7% vs 11.6%, p=0.2) or major (Clavien III or higher) 30-day complication (10.7% vs 9.4%, p=0.7). CONCLUSIONS In this series we observe the majority of PMEs are ordered for routine preoperative evaluation without a specific clinical question and that PMEs rarely affect perioperative management with no difference in surgical outcomes after RP. These findings strongly suggest that routine referral for PME without a specific clinical question can be safely omitted without negatively impacting patient outcomes, with important implications for optimizing value of care. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e1182 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Nima Almassi More articles by this author Michelle Ponziano More articles by this author Howard Goldman More articles by this author Venkatesh Krishnamurthi More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...