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A Population-Based Study of Anesthesia Consultation Before Major Noncardiac Surgery
Duminda N. Wijeysundera, MD;
Peter C. Austin, PhD;
W. Scott Beattie, MD, PhD;
Janet E. Hux, MD, MSc;
Andreas Laupacis, MD, MSc
Arch Intern Med. 2009;169(6):595-602.
Background In single-center studies, consultation by an anesthesiologist days to weeks before surgery was associated with reduced patient anxiety, case cancellations on the day of surgery, and duration of hospitalization. Nonetheless, the impact of anesthesia consultation on outcomes in the population remains unclear.
Methods We used population-based, linked, administrative databases to conduct a cohort study of patients, aged 40 years and older, who underwent selected elective intermediate- to high-risk noncardiac surgical procedures in Ontario, Canada, between April 1, 1994, and March 31, 2004. Propensity-score methods were used to construct a matched-pairs cohort that resolved important differences between patients who underwent consultation and those who did not. We then determined the association of consultation (within 60 days before surgery) with hospital length of stay and postoperative mortality (30-day and 1-year) rates within the matched pairs.
Results Of the 271 082 patients in the entire cohort, 39% (n = 104 716) underwent anesthesia consultation. The proportion of patients who underwent consultation increased from 19% in 1994 to 53% in 2003. Within the matched-pairs (n = 180 254), consultation was associated with reduced mean hospital length of stay (8.17 days vs 8.52 days; difference, –0.35 days; 95% confidence interval [CI], –0.27 to –0.43; P < .001). Consultation was not associated with reduced mortality at 30 days (relative risk, 1.04; 95% CI, 0.96 to 1.13; P = .36) or 1 year (relative risk, 0.98; 95% CI, 0.95 to 1.02; P = .20).
Conclusions Preoperative anesthesia consultation is associated with reduced length of stay but not with reduced mortality. Future research should evaluate the cost-effectiveness of the increasing use of anesthesia consultation.
Author Affiliations: Institute for Clinical Evaluative Sciences (Drs Wijeysundera, Austin, Hux, and Laupacis), Department of Anesthesia, Toronto General Hospital and University of Toronto (Drs Wijeysundera and Beattie), Departments of Health Policy Management and Evaluation (Drs Wijeysundera, Austin, Hux, and Laupacis) and Public Health Sciences (Dr Austin), University of Toronto, Department of Medicine, Sunnybrook Health Sciences Centre and University of Toronto (Dr Hux), Keenan Research Centre, Li Ka Shing Knowledge Institute of St Michael's Hospital (Dr Laupacis), and Department of Medicine, St Michael's Hospital and University of Toronto (Dr Laupacis), Toronto, Ontario, Canada.
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