Analysis of Patients Consulted to the Department of Anesthesiology for Elective Surgery

Song, Jeong Ja; Oh, Kyung Hak; Han, Young Jin; Song, He Sun

Abstract

Many surgical procedures are delayed or cancelled due to inadequate preoperative assess- ment and preparation. To improve patient care and minimize operative delays and cancella- tions, preoperative evaluation and preparation of medically compromised patients is neces- sary. We analyzed 174 cases of written interdepartmental consultations submitted to our department from January 1991 to December 1992. Thus we expected more systemized and improved preoperative consultstion from reviewing the past consultations. The analysis were as follows: 1. The overall consultation rate was 1.38%. 2. Age distribution : 21.8% of total consulted cases were in the fifties and 39.7% were over 60 years old. 3. Sex distribution: Male : Female = 58%: 42%. 4. Departmental distribution of consultation : orthopedic surgery 41.4%, general surgery 16.7 %, neurosurgery 12.6%, urology 12.6%. 5. Interdepartmental consultation rate: orthopedic surgery 4.4%, urology 3.1%, neurosurgery 1.9%, cardiothoracic surgery 1.1%. 6. The primary reasons for consultation were related to the cardiovascular system (28.8% of cases), gastrointestinal system including hepatic disease(24%), respiratory system(23% ) and the endocrine system(15% ). Among the cardiovascular problems, 58% were associated with hypertension and 33% were associated with EKG abnormalities. The most frequently consulted problem was hepatic disease ineluding elevated transaminases(50 cases, 21.5% ) followed by hypertension(39 cases, 16.7%), diabetes mellitus(26 cases, 11.2% ) and EKG abnormalities(22 cases, 9.4%). 7. Results of consultation: 1) Frequency of consultation : 166 eases (95.4%) were once and the rest were twice. 2) Contents of problems : 129 cases(74.1%) had single problem, 35 cases(20.1%) had two problems, 8 cases(4.6%) had three problems. 3) Operation was done in 115 cases (66.1% of the consulted cases), delayed in 42 cases(24.1%) and cancelled in 17 cases(9.8%). Major causes of delay of elective surgery were elevated transaminases(26.4%) followed by hypertenaion(20.4%), diabetea. mellitua(15.1 %), others were tuberculosis and abnormal PFT. Major causes of cancellation were similar to that of delayed surgery, i.e., elevated transaminases(35.3%), decreased pulmonary function (14.8% ), liver cirrhosis (14.8%). Above results suggested thst the more systemized protocol may be needed to minimize the delay and cancellation of elective surgery.