Is preoperative screening clinic cost-effective?

Introduction:
Each year between $11 and $3o million are spent on preoperative testing; this includes the cost of
laboratory tests and related consultations. For an anesthesiologist, the preoperative evaluation is an
important feature of a patients overall anesthetic experience. The preoperative evaluation may be
performed in many settings; however, regardless of the type of evaluation performed, two central
features of the evaluation are risk stratification and optimization of medical conditions. Ideally, the
evaluation will improve both the presurgical process and the outcome after anesthesia and surgery.
Rarely, the assessment may alert the anesthesiologist, surgeon, or patient of potential issues that may
lead to postponement or reconsideration of the benefits of surgery versus the risk identified. Currently,
80% of all surgeries are oupatient or some-day admissions, and it is not surprising that this has led to
an increase in the development of preoperative assesment pathways that can accomodate the
outpatient surgical setting. Although the American Society of Anesthesiologist (ASA) Guidelines for
preoperative assessment recommended that patients with complex medical conditions or those
undergoing complex surgery be seen by an anesthesiologist before the day of surgery, they do not
recommend a particular venue. Outpatient evaluation clinics have become more relevant as
ambulatory surgery has expanded and same-day admissions have become more prevalent.