Adverse Outcomes Up With Medical Consult Before Elective Surgery

MONDAY, March 27, 2023 (HealthDay News) — Preoperative medical consultation prior to elective surgery is associated with an increase in adverse postoperative outcomes, according to a study published online March 27 in JAMA Internal Medicine.

Weiwei Beckerleg, M.D., M.P.H., from the University of Ottawa, and colleagues conducted a retrospective cohort study using linked administrative databases to examine the association of preoperative medical consultation with adverse postoperative outcomes and use of processes of care. Data were included for 530,473 Ontario residents aged 40 years or older who underwent an intermediate- to high-risk noncardiac operation, of whom 186,299 received preoperative medical consultation. A total of 179,809 well-matched pairs were included after propensity score matching.

The researchers found that the 30-day mortality rate was 0.9 and 0.7 percent in the consultation and control groups, respectively (odds ratio, 1.19). The consultation group had higher odds ratios for one-year mortality, inpatient stroke, in-hospital mechanical ventilation, and 30-day emergency department visits (odds ratios, 1.15, 1.21, 1.38, and 1.07, respectively); no difference was seen in the rates of inpatient myocardial infarction. The lengths of stay in acute care were a mean of 6.0 and 5.6 days in the consultation and control groups, respectively; the median total 30-day health system cost was US$235 higher in the consultation group.

“Preoperative medical consultation prior to elective surgery was associated with potential harm,” the authors write. “Because consultation requires effort and resources from patients, clinicians, and the health care system, ongoing support for preoperative medical consultation should hinge on the production of credible evidence of benefit.”

One author disclosed financial ties to AstraZeneca.

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