OUTPATIENT INTERNAL-MEDICINE PREOPERATIVE EVALUATION - A RANDOMIZED CLINICAL-TRIAL

The purpose of this study was to evaluate the effect on resource use o f a program outpatient internal medicine preoperative evaluation in a two arm parallel design randomized clinical trial. In a tertiary care teaching Veterans Affairs hospital, 355 patients (179 inpatient arm, 1 76 outpatient arm)(mean age 65.5 years) were referred for internal med icine preoperative evaluation before elective surgery. Outpatient inte rnist preoperative evaluation was performed 2 to 3 weeks before admiss ion for surgery in the experimental arm with preoperative laboratory a nd radiology testing performed during the visit. The control arm was a dmitted for surgery without outpatient evaluation. The main outcome me asure was the length of stay. Preoperative length of stay was signific antly reduced from 2.9 days in the inpatient arm to 1.6 days in the ou tpatient arm W < 0.001, 95% confidence interval of the difference, -0. 8 to -1.8 days). Postoperative length of stay in the outpatient arm (3 .6 days) was slightly but not significantly longer than the inpatient arm (3.0 days) (95% confidence interval of the increase, -0.6 to 1.8 d ays). Total length of stay showed no significant difference between th e outpatient (5.5 days) and inpatient (6.0 days) arms (95% confidence interval of the difference, -2.0 to 1.1 days). Unnecessary admissions, defined as patients admitted who were admitted but did not undergo su rgery, were decreased significantly comparing the inpatient arm (12.3% ) to the outpatient arm (5.7%) (95% confidence interval of the differe nce, 0.5% to 12.7%). Measures of resource use showed no difference bet ween arms including laboratory tests (95% C.I. of the difference, -3.0 to 6.8 tests), imaging tests (95% C.I. of the difference, -0.5 to 0.8 tests) were administered. A significant increase in the use of consul tants between the outpatient arm (1.3 consultations) and inpatient arm (0.9 consultations) was discovered (95% C.I. of the difference, 0.2 t o 0.6). Patients health status after discharge and satisfaction with c are were not different between the two arms of the investigation. A pr ogram of outpatient internal medicine preoperative evaluation signific antly reduced preoperative length of stay with a lesser effect on tota l length of stay. Unnecessary admission of patients for elective surge ry were reduced by this program.