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Role of history and physical examination in preoperative evaluation

Published online by Cambridge University Press:  12 July 2005

W. A. van Klei
Affiliation:
University Medical Centre Utrecht, Department of Perioperative Care and Emergency Medicine, Utrecht, The Netherlands Julius Centre for General Practice and Patient Oriented Research, University Medical Centre Utrecht, Utrecht, The Netherlands
D. E. Grobbee
Affiliation:
Julius Centre for General Practice and Patient Oriented Research, University Medical Centre Utrecht, Utrecht, The Netherlands
C. L. G. Rutten
Affiliation:
Weezenlanden Hospital, Isala Clinics, Department Anaesthesiology, Zwolle, The Netherlands
P. J. Hennis
Affiliation:
University Medical Centre Utrecht, Department of Perioperative Care and Emergency Medicine, Utrecht, The Netherlands
J. T. A. Knape
Affiliation:
University Medical Centre Utrecht, Department of Perioperative Care and Emergency Medicine, Utrecht, The Netherlands
C. J. Kalkman
Affiliation:
University Medical Centre Utrecht, Department of Perioperative Care and Emergency Medicine, Utrecht, The Netherlands
K. G. M. Moons
Affiliation:
University Medical Centre Utrecht, Department of Perioperative Care and Emergency Medicine, Utrecht, The Netherlands Julius Centre for General Practice and Patient Oriented Research, University Medical Centre Utrecht, Utrecht, The Netherlands
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Abstract

Summary

Background and objective: Since reports have shown that outpatient preoperative evaluation increases the quality of care and cost-effectiveness, an increasing number of patients are being evaluated purely on an outpatient basis. To improve cost-effectiveness, it would be appealing if those patients who are healthy and ready for surgery without additional testing could be easily distinguished from those who require more extensive evaluation. This paper examines whether published studies provide sufficient data to determine how detailed preoperative history taking and physical examination need to be in order to assess the health of surgical patients and to meet the objective of easy and early distinction.

Methods: A MEDLINE search was conducted from 1991 to 2000 with respect to preoperative patient history and physical examination. Altogether, 213 articles were found, of which 29 were selected. Additionally, 38 cross-references, 7 articles on additional testing and 4 recently published papers were used.

Results: It is questionable to what extent an extensive history is relevant for anaesthesia and long-term prognosis. With respect to physical examination, it seems unreasonable to diagnose valvular heart disease based on cardiac auscultation only, and it is unclear which method should be used to predict the difficulty of endotracheal intubation. The benefits of routine testing for all surgical patients before operation are extremely limited and are not advocated.

Conclusions: The amount of detail of preoperative patient history and the value of physical examination to obtain a reasonable estimate of perioperative risk remains unclear. Although not evidence based, a thorough history taking and physical examination of all patients before surgery seems important until more evidence-based guidelines become available. Diagnostic and prognostic prediction studies may provide this necessary evidence.

Type
Original Article
Copyright
2003 European Society of Anaesthesiology

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