The Hidden Value of Elective Orthopaedic Pre-operative Assessment: Incidental Medical Findings Requiring Investigation

Abstract

Background

Anesthetic preoperative assessment is a cornerstone of safe elective surgery, particularly as we deal with an aging and increasingly comorbid population. Preassessment allows an opportunity to optimize pa tients for surgery and has the potential to uncover medical issues of which the patient was previously unaware. The purpose of the study was to explore the number of new incidental medical diagnoses uncovered during routine preoperative assessment for elective orthopaedic procedures.

Methods

A retrospective chart review was carried out of patients attending preoperative assessment at Cappagh National Orthopedic Hospital between July and December of 2022. In total, 500 patients were included. Patient demographics and outcomes of preoperative assessment, including any new medical diagnosis as well as routine hemoglobin values, body mass index, and electrocardiogram findings, were recorded in encrypted and anonymized data files. In total, following the exclusion of incomplete or duplicated records as well as nonarthroplasty cases, 482 patients were included in this study. The average age of participants was 67 years (range, 29 to 90), with 264 (54.7%) women and 218 (45.2%) men. The majority of patients were being preassessed for elective joint arthroplasty.

Results

The most common new incidental diagnoses were cardiac in nature, with 36 (7.5%) patients of the overall cohort requiring new onward referrals to a cardiology service. In total, 63 or 13% of patients, required new medical management, and 45 patients overall or 9.3% were deemed not fit to proceed to surgery at the initial preassessment with further investigations required.

Conclusions

Preoperative anesthetic assessment plays a key role in the optimization of patients for elective orthopaedic procedures. Our study also highlights a secondary benefit of uncovering a major number of incidentally discovered new medical diagnoses, in particular cardiac. This secondarily benefits the patient by allowing for earlier detection and treatment of potentially life-threatening comorbidities.