Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1016/j.bjan.2012.07.005
Brazilian Journal of Anesthesiology
Scientific Article

Avaliação pré-operatória: triagem por meio de questionário

Preoperative evaluation: screening using a questionnaire

Florentino Fernandes Mendes; Eduardo Lopes Machado; Maurício de Oliveira; Fernando Rudem Brasil; Gibrahn Eizerik; Patrick Ely Telöken

http://dx.doi.org/10.1016/j.bjan.2012.07.005 Braz J Anesthesiol, vol.63, n4, p.347-352, 2013
PDF Português
PDF English
Downloads: 0
Views: 1134

Resumo

JUSTIFICATIVA E OBJETIVOS: Antes de cirurgia eletiva é indispensável conhecer com antecedência as condições clínicas do paciente. O objetivo deste estudo foi comparar a avaliação pré-operatória (APO) por meio do preenchimento de um questionário com a consulta realizada pelo anestesiologista. MÉTODO: Antes da consulta pré-operatória, os pacientes responderam a um questionário com informações sobre idade, peso, altura, cirurgia planejada, história médica e cirúrgica pregressa, alergias, medicamentos e doses usadas, história social (drogas ilícitas, álcool, tabagismo), capacidade funcional e tolerância ao exercício. A consulta pré-operatória foi realizada por anestesiologista que não tinha acesso aos dados do questionário nem conhecimento da pesquisa. Os dados obtidos por meio do questionário foram comparados com a consulta pré-operatória por dois pesquisadores independentes, com a finalidade de responder às perguntas: 1) A avaliação pelo questionário foi suficiente - o paciente poderia ser conduzido à cirurgia sem necessidade da avaliação presencial? 2) Houve alguma informação relevante - capaz de mudar a conduta anestésica - que o questionário não aferiu, mas que a consulta presencial avaliou? 3) Houve alguma informação acrescentada pelo questionário de saúde que a consulta presencial não obteve? Para análise estatística usou-se o teste t de Student pareado para dados paramétricos e o teste Qui-quadrado para dados categóricos com P < 0,05. RESULTADOS: Dentre os 269 pacientes elegíveis houve uma recusa, quatro aceitaram participar mas não preencheram o questionário e houve 52 perdas, totalizando 212 participantes. O questionário acrescentou dados à consulta em 109 casos (51,4%). A triagem apenas pelo questionário foi suficiente - não necessitou de consulta presencial - em 144 pacientes (67,93%). A avaliação realizada pelo anestesiologista liberou para a cirurgia na primeira consulta em 178 oportunidades (84%). Na identificação dos casos de não liberação para cirurgia, o questionário apresentou valor preditivo negativo de 94,4%, valor preditivo positivo de 38,2%, sensibilidade de 76,5% e especificidade de 76,4%. Houve fatores clínicos estatisticamente significativos (P < 0,05) associados com não liberação para a cirurgia: idade acima de 65 anos, IMC > 30, baixa capacidade funcional, hipertensão arterial, diabetes mellitus, asma, insuficiência renal, hepatite e cardiopatia isquêmica. CONCLUSÕES: O uso do questionário foi efetivo para triagem de pacientes que necessitam de avaliação complementar e/ou alteração de regime terapêutico previamente ao procedimento eletivo. Além disso, o questionário acrescentou dados não contemplados pela avaliação clínica.

Palavras-chave

AVALIAÇÃO, Pré-anestésica, ANESTESIOLOGIA, Consultório, Fatores de Risco, Questionários

Abstract

BACKGROUND AND OBJECTIVE: Prior to elective surgery it is essential to know in advance the patient’s clinical condition. The aim of this study was to compare the preoperative evaluation (POE) through questionnaire responses with preanesthetic evaluation by the anesthesiologist. METHOD: Prior to their preoperative evaluation, patients answered a questionnaire with information regarding age, weight, height, scheduled surgery, past medical and surgical history, allergies, medications and doses used, social history (illicit drugs, alcohol, smoking), functional capacity and exercise tolerance. Preoperative evaluation was performed by an anesthesiologist who had no access to the questionnaire data or knowledge about the research. The questionnaire data were compared with the preoperative evaluation by two independent investigators, in order to answer the questions: 1) Was the questionnaire evaluation effective - could the patient undergo surgery without the need for face-to-face consultation? 2) Has been there any relevant information - ability to change the anesthetic approach - not assessed by the questionnaire, but assessed by the face-to-face consultation? 3) Has been there any information added by the health questionnaire that was missed by face-to-face consultation? For statistical analysis, the paired Student’s t-test was used for parametric data and chi-square test for categorical data, with p < 0.05 considered significant. RESULTS: Of the 269 eligible patients there was one refusal, and four agreed to participate but did not complete the questionnaire, in addition to 52 losses, totaling 212 participants. Questionnaire data added to the consultation in 109 cases (51.4%). The screening questionnaire alone was effective for 144 patients (67.93%), with no need for consultation. The anesthesiologist evaluation referred patients for surgery on their first visit in 178 opportunities (84%). In the identification of cases of non-referral to surgery, the questionnaire showed a negative predictive value of 94.4%, positive predictive value of 38.2%, sensitivity of 76.5%, and specificity of 76.4%. Statistically significant (P < 0.05) clinical factors associated with non-referral to surgery were: age over 65 years, BMI > 30, low functional capacity, hypertension, diabetes mellitus, asthma, renal failure, hepatitis, and ischemic heart disease. CONCLUSION: The questionnaire was effective for screening patients who needed further evaluation and/or changes in treatment regimen prior to elective surgery. Moreover, the questionnaire added data not covered by clinical evaluation.

Keywords

Anesthesiology, Consultants, Preoperative Care, Questionnaires, Risk Factors

References

Fischer S. Development and effectiveness of an anesthesia preoperative evaluation clinic in a teaching hospital. Anesthesiology. 1996;85:196-206.

Pollard JB, Garnerin P, Dalman RL. Use of outpatient preoperative evaluation to decrease length of stay for vascular surgery. Anesth Analg. 1997;85:1307-1311.

Van Klei WA, Moons KG, Rutten CL. The effect of outpatient preoperative evaluation of hospital inpatients on cancellation of surgery and length of hospital stay. Anesth Analg. 2002;94:644-699.

Preoperative evaluation. 1997.

Viewpoint on preoperative care. 2002:8-9.

Lemmens LC, Kerkkamp HE, van Klei1 WA. Implementation of outpatient preoperative evaluation clinics: facilitating and limiting factors. Br J Anaesth. 2008;100:645-651.

Resolução 1802/2006. 2006.

Kluger MT, Tham EJ, Coleman NA. Inadequate preoperative evaluation and preparation: a review of 197 reports from the Australian incident monitoring study. Anaesthesia. 2000;55:1173-1178.

Bader AM, Sweitzer B, Kumar K. Nuts and bolts of preoperative clinics: the view from three institutions. Clev Clin J Med. 2009;76:S104-S111.

Yen C, Tsai M, Macario A. Preoperative evaluation clinics. Curr Opin Anaesthesiol. 2010;23:167-172.

Schein OD, Katz J, Bass EB. The value of routine preoperative medical testing before cataract surgery. N Engl J Med. 2000;342:168-175.

Chung F, Yuan H, Vairavanathan S, Wong D. Elimination of preoperative testing in ambulatory surgery. Anesth Analg. 2009;108:467-477.

Sandler G. The importance of the history in the medical clinic in the cost of unnecessary tests. Am Heart J. 1980;100:928-931.

Badner NH, Craen RA, Paul TL. Anaesthesia preadmission: a new approach through use of a screening questionnaire. Can J Anaesth. 1998;45:87-92.

Digner M. At your convenience: preoperative assessment by telephone. J Perioper Pract. 2007;17:294-301.

Law TT, Suen DT, Tam YF. Telephone preanaesthesia assessment for ambulatory breast surgery. Hong Kong Med J. 2009;15:179-182.

Pesquisa Nacional por Amostra de Domicílios (Pnad) 2009. .

Sandberg E, Sharma R, Wicklund R, Sandberg W. Clinicians consistently exceed a typical person's short term memory during preoperative teaching. Anesth Analg. 2008;107:972-978.

Edward GM, Lemaire LC, Preckel B. Patient experiences with the preoperative assessment clinic (PEPAC): validation of an instrument to measure patient experiences. Br J Anaesth. 2007;99:666-672.

Hepner DL, Bader AM, Hurwitz S. Patient satisfaction with the preoperative assessment in a preoperative assessment testing clinic. Anesth Analg. 2004;98:1099-1105.

5dd401340e8825d31bc63494 rba Articles
Links & Downloads
2352-2291 (Electronic) 0104-0014 (Printed)
Braz J Anesthesiol ©2024 All rights reserved.

Braz J Anesthesiol

Share this page
Page Sections