Objectives: To collect and summarize information published by
INAHTA agencies on the indications, habitual attitudes and practices,
and economic and legal implications of preoperative evaluation in
elective surgeries.
Method: The authors appraised the information
contained in six papers published between 1989 and 1999 in Sweden,
France, Basque Country, the Netherlands, United Kingdom, and
Catalonia. The section on indications in preoperative evaluation
does not present global conclusions. The sections addressing
habitual attitudes and practices among physicians and those
addressing economic and legal considerations cover only the
similarities among the reports and the main ideas relating to these
issues.
Results: The conclusions found in the reports about indications
in preoperative evaluation are similar or differ slightly, e.g., as
regards age limits in patients for whom the tests are recommended.
However, more important differences are shown in other areas,
especially in reports where consensus methods were used. In some
instances, the opinions, attitudes, and customary practices of
professionals during the preoperative stage do not concur with the
recommendations extracted from the assessment reports and the
customary practice of doctors. In relation to economic
considerations, a substantial quantity of resources could be
liberated if the recommended general clinical practices were
followed. From the point of view of civil law, the evidence-based
recommendations could be considered as a
kind of coded lex artis.