Original Title: Pertinence des consultations et tests préopératoires pour une chirurgie élective à faible risque chez les personnes de 16 ans et plus

Authors' objectives: For people undergoing a low-risk surgery, medical consultations or preoperative tests rarely lead to a change in management by the care team. These unnecessary requests in the preoperative context generate overuse of resources, delays, and costs for the healthcare system and the patient. With the aim of reducing the number of requests for low-value preoperative consultations and tests, the Ministère de la Santé et des Services sociaux and the Institut pour la pertinence des actes médicaux (IPAM) have mandated the Institut national d'excellence en santé et en services sociaux (INESSS) to develop a guide to support those involved in preoperative clinics, and to optimize and harmonize practices in Quebec healthcare settings.

Authors' results and conclusions: Following analysis of all the information gathered and an iterative process with the advisory committee members, findings and recommendations emerged regarding the use of preoperative medical consultations and tests for patients undergoing low-risk elective surgery. These surgeries should meet the following criteria: conducted on an outpatient basis (day surgery), of short duration, minimally invasive, and at low risk of complications. (#1 PREOPERATIVE HEALTH STATUS ASSESSMENT: A PREREQUISITE FOR CONSIDERING PREOPERATIVE MEDICAL CONSULTATION AND TESTING): Requests for preoperative consultations and tests should be tailored to the patient's health status and the risks associated with surgery. A preoperative assessment of the patient's health status should be carried out beforehand, to identify any health problems, medical history, medication, or treatment taken, lifestyle habits, possibility of pregnancy, or the presence of new or worsened signs or symptoms. (#2 PREOPERATIVE MEDICAL CONSULTATIONS AND TESTS: NOT ROUTINELY RECOMMENDED, BUT COULD BE CONSIDERED DEPENDING ON CLINICAL CONSIDERATIONS): Routine preoperative medical consultations and tests are not recommended for patients undergoing low-risk elective surgery. However, based on specific clinical considerations identified during the preoperative assessment of the patient’s health status, medical consultations or preoperative tests could be considered if the result is likely to modify perioperative management. For low-risk surgery, electrocardiogram, creatinine and ion levels, blood glucose and glycated hemoglobin levels, complete blood count, international normalized ratio and activated partial thromboplastin time tests, albumin, alanine aminotransferase, and bilirubin levels could be considered, depending on specific clinical considerations. However, in the presence of new or worsening signs or symptoms, investigation outside the preoperative course should be conducted in accordance with good clinical practice. If there is a possibility of pregnancy, or a suspicion of cognitive decline, frailty, or sleep apnea, an evaluation of these conditions should be considered if the results are likely to modify perioperative management. Similarly, for urological surgery or if the operative area may be in contact with urine, a urine summary, microscopy, and culture could be considered, if the result is likely to modify perioperative management. (#3 AVOID REPEATING TESTS WHOSE RESULTS ARE AVAILABLE AND VALID): Unless there is a change in the patient's health status, preoperative test results are valid for 3 to 6 months and do not need to be repeated if they are available in the patient's file. CONCLUSION: Without replacing clinical judgement, the application and implementation of the recommendations proposed in this guide could allow for better resource utilization and harmonization of practices in the preoperative evaluation context. However, the potential impact of these recommendations will depend on several factors, such as active distribution of the guide, commitment of institutional and preoperative clinic managers to adopting the recommendations, appropriation by the clinicians concerned, and implementation of strategies to facilitate their application and appropriation by the community, in particular through the monitoring of targeted indicators.

Authors' methods: A rapid review of the literature on the use of preoperative medical consultations and tests published between 2012 and 2023 was carried out according to the INESSS rapid review guidelines. Contextual information (e.g., questionnaires, preoperative test requests, individual, and group prescriptions) was collected from preoperative clinics in Quebec. An advisory committee composed of healthcare professionals and managers involved in the surgical trajectory was formed to gather experiential knowledge and assist in contextualizing the recommendations. The overall quality of the work, its acceptability, and applicability were appraised by a monitoring committee, external reviewers, and future users.

Authors' identified further research: The relevance of updating the recommendations will be evaluated in five years' time from the date of publication, according to the progress of scientific data and the evolution of clinical practices, as well as the needs of the health and social services network.

Project Status: Completed

URL for project: https://www.inesss.qc.ca/publications/repertoire-des-publications/publication/pertinence-consultations-tests-preoperatoires-personnes-de-16-ans-et-plus.html

Year Published: 2024

URL for published report: https://www.inesss.qc.ca/publications/repertoire-des-publications/publication/pertinence-consultations-tests-preoperatoires-personnes-de-16-ans-et-plus.html

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Canada

Province: Quebec

Organisation Name: Institut national d'excellence en sante et en services sociaux

Contact Address: L'Institut national d'excellence en sante et en services sociaux (INESSS) , 2021, avenue Union, bureau 10.083, Montreal, Quebec, Canada, H3A 2S9;Tel: 1+514-873-2563, Fax: 1+514-873-1369

Contact Name: demande@inesss.qc.ca

Contact Email: demande@inesss.qc.ca

Copyright: L'Institut national d'excellence en sante et en services sociaux (INESSS)