OPERATIONS ON PATIENTS DEEMED UNFIT FOR OPERATION AND ANESTHESIA - WHAT ARE THE CONSEQUENCES

Background: The decision ''patient unfit for anaesthesia and operation '' is likely to cause a delay of the scheduled operation. This retrosp ective evaluation was done: 1) to determine the correctness of preoper ative tentative diagnoses of coexisting dis eases making anaesthesia a nd operation excessively risky in relation to the physician's training status; 2) to examine the question of whether preoperative medical ma nagement modified according to the anaesthesiologist's suggestions had a positive impact on the perioperative course. Methods: The medical r ecords of patients scheduled for elective non-cardiac surgery who were rated ''unfit for operation and anaesthesia'' were evaluated. The acc uracy of the tentative diagnoses was examined for relation to the trai ning status of the anaesthesiologists. The preoperative management was tested for its impact on postoperative outcome. Results: During the o bservation period 16 122 patients underwent preoperative anaesthesiolo gical assessment; 1021(6.3%) were initially considered to be unfit for operation and anaesthesia. The records of 807 patients were available for review. The accuracy of the tentative diagnoses was 70%, and was not significantly affected by the training status of the physicians (P =0.022). Four hundred and seventeen patients were excluded from the se cond part of the investigation (discharged without operation, underwen t operation using local anaesthesia or tentative diagnosis not confirm ed). Three hundred and ninety patients were operated under general ana esthesia. Group I(n=216) was managed according to the anaesthesiologis t's suggestions and was found to have a significantly lower complicati on rate (18.1%) than group II (n=174) in which the suggestions from th e preoperative assessment were ignored (32.2%; P<0.05). The perioperat ive mortality rate in group I was 2.3% compared with 5.2% in group II (n.s.; P>0.05). Conclusions: We conclude that the anaesthesiology deci sion ''patient unfit for operation and anaesthesia'' has a high accura cy, independent of the anaesthesiologist's training status, and that p reoperative medical management significantly reduces complications.