The clinical profile of patients referred for preoperative anaesthetic evaluation at Chris Hani Baragwanath Academic Hospital

Abstract

Background Preoperative anaesthetic evaluation of patients that are due to undergo surgery is an integral component of providing safe anaesthesia to high-risk surgical patients. There is a paucity of data in South Africa regarding the clinical profile of patients referred for formal preoperative anaesthetic evaluation. The aim of this study was to describe the profile of patients referred for preoperative anaesthetic consultations at Chris Hani Baragwanath Academic Hospital based on their clinical and surgical factors, perioperative risk profile and anaesthetic recommendations.

Methods A retrospective study using consecutive sampling was done by reviewing the 271 records of the preoperative anaesthetic consultations done from 1 January 2019 to 31 December 2019. Age was analysed as a continuous variable and is reported using mean and standard deviation. All other variables were categorical and are summarised using counts and percentages.

Results The mean (SD) age of patients referred was 49.9 (19.3) years. There was a predominance (80.1%) of female patients, with obstetrics accounting for the majority (38.1%) of all referrals. Most patients had multiple comorbidities with hypertension prevailing as the most common comorbidity. Regarding risk stratification, most patients were classified as ASA-PS three (55.9%), with an effort tolerance of more than four METS (74.6%) and a RCRI score of one (51.0%). The anaesthetic recommendations made showed that 98.5% of patients were fit for anaesthesia of which 85.2% could proceed to surgery without delay and 14.8% required a delay in surgery for further optimisation. Modification of anaesthetic technique was recommended in 196 (74.2%) of these patients. From the 137 (51.9%) patients requiring further optimisation a total of 383 modalities of optimisation were requested. This encompassed 57 medical treatment modalities, 213 further investigations and 113 interdisciplinary consultations.

Conclusion This study has given us further insight on the clinical profile and perioperative requirements of high-risk patients requiring surgery at CHBAH. It has emphasised the importance of the preoperative anaesthetic consultation in providing safe and quality care to all patients presenting for surgery.