The Effect of Consultations on the Cost of Pre-Anesthetic Assessment

doi:10.4236/ijcm.2013.411087

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International Journal of Clinical Medicine, 2013, 4, 496-498

Published Online November 2013 (http://www.scirp.org/journal/ijcm)

http://dx.doi.org/10.4236/ijcm.2013.411087

Open Access IJCM

The Effect of Consultations on the Cost of Pre-Anesthetic

Assessment

Omer L. Erhan1, Azize Bestas1,2*, Sait F. Oner1, Turkay Yucel1, Sib el Ozcan1, Hasan Arık1

1Department of Anesthesiology and Reanimation, Firat University School of Medicine, Elazığ, Turkey; 2Department of Anesthesiol-

ogy and Reanimation, Firat University School of Medicine, Elazığ, Turkey.

Email: *[email protected]

Received September 17th, 2013; revised October 15th, 2013; accepted November 3rd, 2013

which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Background: In our study, researching the distribution of the consultations other than anaesthesia in compliance with

the disciplines and ages of the patients and its effect on the assessment cost has been aimed. Methods: Our study has

been conducted during 8 months by the retrospective assessment of the records of 3844 cases on which an elective sur-

gical procedure was planned in the anesthesiology polyclinic of Firat University Hospital. The records of patients have

been obtained through examining their files from the hospital record system. Results: The total number of patients

whose consultations have been demanded was 367 (9.5%) and the number of male/female was 192/175. The number of

cases about which more than one consultation has been demanded was determined as 87 (2.2%). The number of cases

on which a method change for the anaesthesia was applied was 21 (5.7%), and the number of cases whose surgery was

cancelled was 3 (0.81%). Requested consultation for each patient, the consultations of cardiology, chest diseases and

internal medicine bring an additional cost on the total sum respectively as 37.2 TL (28.61 $), 29.8 TL (22.92 $) and 19.9

TL (15.30 $). Conclusions: We suggest that the cost analysis should be absolutely taken into consideration during the

pre-anaesthetic assessment for the requirement of routine examinations.

Keywords: Pre-Anaesthetic Asessment; Consultations; Costs

1. Introduction

Pre-operative assessment is significant because of the

facts that the planned-surgery may be cancelled or this

assessment may prevent the cancellation of the surgery or

the period of hospitalization may be shortened and more-

over anaesthesia should be performed under the safe

conditions. This assessment, by determining health prob-

lems which are not detected before, enables the revision

of the anaesthetic and surgical approaches and the pre-

vention of undesirable events during the preoperative and

post-operative period. For this purpose, during the pre-

operative period, many laboratory tests and examinations

are conducted on patients [1]. The consultations other

than anaesthesia compose some part of this assessment.

These consultations are applied because accompanied

diseases bring additional costs on the routine assessment.

In our study, researching the distribution of the con-

sultations other than anaesthesia in compliance with the

disciplines and age groups and its effect on the asse-

ssment cost has been aimed.

2. Materials and Methods

Our study has been conducted during 8 months by the

retrospective assessment of the records of 3844 cases on

which an elective surgical procedure was planned in the

anesthesiology polyclinic of Firat University Hospital.

The records of patients have been obtained through ex-

amining their files from the hospital record system. Pre-

operative tests for the age group of under 15 years, com-

plete blood count, fixing of blood group, blood glucose

level, aspartate transaminase, alanine transaminase, uri-

nalysis, activated partial thromboplastin time and pro-

thrombin time have been accepted as routine costs. Elec-

trocardiogram, for the patients more than 35 years old

and postero-anterior chest X-ray and renal function tests

for those who are more than 65 years old are added to

these tests and the routine cost has been found. For each

patient for whom the consultation has been demanded the

name, surname, protocol, age (pediatric age <15 years,

*Corresponding author.

The Effect of Consultatıons on The Cost of Pre-anesthetıc Assessment 497

adult age 15 to 65 years and geriatric age >65 years),

weight, gender, information about from which service of

the hospital she/he comes, his/her planned-operation, the

reason of the consultation demanded, additional tests

demanded as a result of the consultation, and the changes

on the anaesthesia technique have been recorded. It has

been found that in compliance with the age groups and

related disciplines (Cardiology, Chest Diseases, Internal

Medicine), the cases for which consultation is demanded

by considering pre-operative pathology bring an addi-

tional cost to the total sum of the consultation.

For the calculation of the costs, the prices fixed and

applied for the year of study by the Precept of Budget

Practice (PBP) of the Ministry of Finance have been

taken into consideration. Based on the value of the time,

the cost has been also fixed as USA dollar ($) by consid-

ering 1.3 TL = 1$ TL.

3. Results

When the findings of 3844 patients have been assessed,

the total number of patients whose consultations have

been demanded were recorded as 367 (9.5%) and the

number of male/female was found as 192/175. When

examined in compliance with the age groups, the con-

sultation has been demanded for 8 patients (2.1%) who

are under 15 years old, 228 patients (62.1%) who are

between 15 to 65 years old and 131 patients (35.6%) who

are more than 65 years old. The number of cases about

which more than one consultation has been demanded

was fixed as 87 (2.2%). The number of cases on which a

method change for the anaesthesia was applied was 21

(5.7%), the number of cases whose surgery was can-

celled was 3 (0.81%) and the number of cases which

were diagnosed for the first time is 104.

The cost occured as a result of the consultation has

been recorded in compliance with the disciplines and age

groups (Table 1). It has been determined as routine cost,

additional cost and total cost in compliance with the age

groups (Table 2). When assessed alone, requested con-

sultation for each, patient the consultations of cardiology,

chest diseases and internal medicine bring an additional

cost on the total sum respectively as 37.2 TL (28.61 $),

29.8 TL (22.92 $) and 19.9 TL (15.30 $).

The cost has been found as 62,54 TL (48.10 $)/per

patient for those the cardiology and chest diseases

consultation were demanded 59,07 TL (45.43 $)/per

patient for those internal medicine and chest diseases

consultation were demanded and 43.44 TL (33.41 $)/per

patient for those the cardiology and internal medicine

consultation were demanded.

4. Discussion

During the pre-operative assessment, anamnesis, physical

examination and the choice of examination should be in

Table 1. Units from which consultations have been demand-

ed and the cost. TL: Turkish lira, $: USA dollar.

Cardiology Chest Diseases Internal

Medicine

Consultation

[n(%)] 154

(4.00)

(1.17)

294

(7.64)

Total Cost

• TL

• $ 5298.10

4075.46

1140.40

877.23

955.75

735.19

Table 2. The routine and additional costs [Turkish lira (TL),

USA dollar ($)] in compliance with the age groups.

Cost TL (USA $)

Age (years)Routine costAdditional cost Total cost

<15

15 to 65

>65

26.34 (20.26)

29.34 (22.56)

42.74 (32.87)

18.2 (14.00)

29.60 (22.76)

36.78 (28.29)

44.54 (34.26)

58.94 (45.33)

79.52 (61.16)

connection with the determination of ambigious cases

which have the potential to affect the pre-operative re-

sults [2]. Making the pre-operative assessment by indi-

vidualizing it toward the patient, taking the anamnesis

attentively and making a detailed physical examination

may reduce the demand for consultation other than an-

aesthesia and thus cost. Unnecessary tests and scrutinies

lead hospital service load and cost to increase [2].

Fischer et al. [3] determined that preventing unnecessary

tests may reduce the cost by 55%.

It is known that making the pre-anesthetic assessment

before the operation day prevents last minute cancella-

tions and postponing the surgical operation [4]. Besides

surgery costs related to postponing the case increases,

using the operation room effectively is not possible as the

surgery date can not be clarified. It is reported that a

monetary loss of 1.500 USD per hour for cancellation of

the surgery and 10 USD per minute for postponing the

surgery occurs [5].

Ferrando et al. [6] have found the cost for pre-opera-

tive assessment cost as 6.10 € within the age group of

<15 years old, 27.16 € within the age group of 15 - 65

years old, and 38.48 € within the age group of >65 years

old. The results of this study are similar to ours in terms

of the increase in cost. Gold et al. [7] claimed that ab-

normal findings are significantly high within those who

are more than 60.

The results of our study are significant because of the

fact that the pre-anaesthetic assessment has revealed dif-

ferent costs in compliance with the age groups. As a re-

sult of our assessment, 9.5% of our patients have been

applied the consultations other than anaesthesia.

5. Conclusion

As one becomes older, the proportion of consultation and

Open Access IJCM

The Effect of Consultatıons on The Cost of Pre-anesthetıc Assessment

Open Access IJCM

498

the cost during the pre-anaesthetic assessment rise paral-

lelly to the age. We suggest that the results of our study

are taken into consideration within the framework of the

health policies in terms of revealing different costs in

compliance with the age groups during the preparation of

package programmes while PBP is being prepared.

Therefore, the cost analysis should be absolutely taken

into consideration during the pre-anaesthetic assessment

for the requirement of routine examinations.

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