PubMed · 9187451
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L Walker. 1997. Preadmission testing.. https://doi.org/10.1016/s0001-2092(06)62943-8
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In the spring of 1996, tonsillectomy, traditionally regarded as a procedure requiring hospitalization, began to be performed at the recently started day surgery unit at Danderyd Hospital. The article consists in a report of results obtained with a series comprising just over 200 children who were the first to undergo adenotonsillectomy in day surgery, and followed up, for instance, by questionnaire. There were no cases of complications requiring hospitalization during the first postoperative day. The parents were fairly satisfied with the care provided, though 25 per cent of them said that in the event of a new operation being necessary they would prefer that it be performed as an in-patient procedure.
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The volume of preoperative screening investigations for outpatient anaesthesia ranges from few, selectively ordered investigations to extensive routine diagnostic procedures. It seem appropriate to reevaluate benefit and efficacy of routine preoperative assessment programs. The purpose of preoperative diagnostic is to assess the risk of anaesthesia and surgery for the patient. As shown by a number of studies, preoperative screening investigations seldom disclose new pathological findings of clinical relevance. Abnormal laboratory results in otherwise healthy patients rarely alter the anaesthetic management of the patient and are not related to perioperative complications. Extensive use of costly diagnostic procedures considerably increases health care budgets. A more selective approach to order preoperative investigations promises considerable savings. To achieve costeffective evaluation an efficient organisation of properative assessment must be established to avoid costly delay and on day-of-surgery-cancellations. There is no medicolegal obligation to perform routine diagnostic testing. The anaesthetist must be sufficiently informed in time to assess the perioperative risk of the patient and to alter anaesthetic management as necessary. According to the presented studies a clinical history and a through physical examination represent an effective method of screening for the presence of disease. Careful medical history evaluation and physical examination can avoid extensive investigations in apparently healthy individuals and the latter should only be ordered if indicated.