Outcomes of preoperative medical consultations for elective non cardiac surgical procedures at tertiary care center

Objective: To evaluate the outcome of medical consultations requested at the time of pre-operative anaesthesia assessment. Methodology: After taking exemption from ethical review committee, this descriptive cross-sectional study was conducted for one year at our tertiary care center. All adult patients scheduled for elective surgeries required consultation from anaesthesia physicians were included. Relevant clinical data was recorded prospectively on predesigned Performa. Outcomes were categorized as risk stratification, optimizing medical management or postponement of surgical procedure. Results: Among 264 patients (mean age 59.9 years, predominantly male, ASA III), hypertension, diabetes, and IHD were the common comorbid conditions. About 47% of these consultations were requested for intermediate risk procedures, while cardiology opinion was requested in (63%) of cases. Based on these consultations, 87.5% of patients received risk prediction, medical management was advised in 64% and in only 7.2% of patients the planned surgeries were postponed. Comparison between variables showed Myasthenia Gravis (50%), Pulmonary embolism (33%) and IHD (30%) were the common reasons of falling into high-risk group. Most patients with Asthma (69%), IHD (68%) and Hypothyroidism (52%) required medical intervention preoperatively (p=0.496). IHD was mainly responsible for the reason of delaying surgery (13.6%). Similarly, 69% of cardiac consultations ended up with case postponement, and 53.5% of patients were advised with medical management (p=0.001). Conclusion: The substantial disease burden and proposed risk stratification including recommendations regarding medical optimization justified the need of preoperative consultations in our patient populations. However, their impact on improving postoperative outcomes requires further evaluation.