Preoperative consultations by anesthesiologists

Abstract

Preoperative anesthesia consultation before major surgery presents opportunities to better document comorbid illness, optimize medical conditions, facilitate referrals to specialists, order specialized investigations, initiate interventions to decrease risk, discuss aspects of perioperative care, and arrange appropriate postoperative care. The goal of this review is to discuss the implications of recent studies that have evaluated the processes-of-care and outcomes related to preoperative anesthesia consultation. An increasing proportion of surgical patients undergo outpatient preoperative anesthesia consultation. These consultations effectively communicate information to anesthesia providers in operating rooms, reduce the time required to complete preoperative assessments, improve patients' education about perioperative care, and increase patient acceptance of regional anesthesia. Recent population-based data also demonstrate that consultations are associated with reductions in hospital length-of-stay, but not postoperative mortality. In addition, rates of specialized preoperative cardiac testing are increased following anesthesia consultation but the value of these tests remains debatable. Preoperative anesthesia consultations have become increasingly common and have shown some clear beneficial effects on perioperative care and outcomes. Further research remains needed to identify efficacious interventions for reducing perioperative risk, measure the prognostic value of specialized preoperative tests, and compare the safety of different models for performing preoperative consultations.