TORONTO, Ont. -- Hospitals vary greatly in the number of patients who see an internal medicine specialist before major non-cardiac surgery, with rates ranging from five per cent of patients to 90 per cent, new research has found.
The findings are important because they suggest there are no commonly agreed upon standards for which patients should have such consultations, said Dr. Duminda Wijeysundera, a scientist at the Li Ka Shing Knowledge Institute of St. Michael's Hospital and the Institute for Clinical Evaluative Sciences (ICES).
As a result, some patients may be getting expensive tests and exams they don't need, while others who do need them are not getting them, said Dr. Wijeysundera, who is also an anesthesiologist at Toronto General Hospital-University Health Network.
Dr. Wijeysundera studied the records of 205,000 patients who underwent major elective non-cardiac surgery in 79 hospitals in Ontario from 2004 to 2009. His results were published today in the journal Anesthesiology.
All patients scheduled for elective surgery in Ontario must undergo a preoperative medical history and physical, which are typically done by the patient's family physician or surgeon. Referrals to an internal medicine specialist are usually made at the discretion of the surgeon or anesthesiologist.
One-third of the patients studied underwent a pre-operative medical consultation. Not surprisingly, most were older, were patients at teaching hospitals or hospitals with high volumes of surgery, or had other, pre-existing medical conditions such as diabetes or heart disease.
However, the rates varied widely from hospital to hospital, and could not be explained based on the surgical procedure, the volume of surgeries conducted at the hospital or whether it was a teaching hospital.
"That suggests the forces driving this have little to do with how sick the patient is," Dr. Wijeysundera said. "Further research is need
|Contact: Leslie Shepherd|
St. Michael's Hospital