H. Qiu1, M. Bronsert1,2, L. A. Crane3, R. A. Meguid1,4 1University Of Colorado School Of Medicine,Surgical Outcomes And Applied Research Program,Aurora, CO, USA 2University Of Colorado School Of Medicine,Adult And Child Consortium For Health Outcomes Research And Delivery Science,Aurora, CO, USA 3University Of Colorado Denver School Of Public Health,Department Of Community And Behavioral Health,Aurora, CO, USA 4University Of Colorado School Of Medicine,Department Of Surgery,Aurora, CO, USA
Introduction:
Preoperative surgical risk assessment is a critical aspect of surgical decision making. However, techniques employed by surgical team members vary from sole reliance on clinical experience to use of formal risk analysis tools. We aim to better understand the prevalence of and barriers to the use of formal preoperative surgical risk analysis tools.
Methods:
A 20-question survey was designed, piloted in 10 surgical and anesthesia providers, and refined before administration. The web-based survey was disseminated via email and in person at a single academic hospital to surgical and anesthesiology staff and residents. A total of 12 questions were on risk assessment attitudes and techniques and 8 were on demographics (Figure 1). Results were analyzed with descriptive statistics (Chi-square or Fisher’s exact p value).
Results:
We administered the survey to a convenience sample of 50 surgical and anesthesia providers. Despite 88% of those surveyed reporting the importance of preoperative risk assessment as very or critically important (p<0.001) and 80% of those surveyed reporting discussion of risk preoperatively either most or all of the time (p<0.0001), only 76% of practitioners spend between 0-9 minutes communicating risk preoperatively, and 46% spend 0-4 minutes (p<0.001). When asked about use of 4 formal risk analysis tools, 64-94% of practitioners never use them (p<0.0001). On the contrary, prior experience is reported mostly or always to be a source of preoperative risk assessment (90% surveyed, p<0.0001). Survey of barriers preventing use of formal risk analysis tools identified 4 significant findings: time, electronic health record integration, inaccessibility during patient visit, and trust of accuracy were all reported as moderate to significant barriers by 94%, 74%, 88%, and 80% of respondents, respectively (all p-values <0.001).
Conclusion:
Although the prevalence of preoperative risk discussion is high, usage of formal risk analysis tools are infrequent and non-uniform amongst providers. The majority of practitioners relied on prior experience alone for preoperative risk evaluation. Statistically significant barriers against use of formal risk analysis tools include lack of time, lack of electronic health record integration, inaccessibility during patient visit, and lack of trust of tool accuracy. Given the data collected, we conclude there is limited use and significant barriers to use of formal preoperative risk analysis tools, and that time spent discussing surgical risks preoperatively is low despite the importance placed on it by surgical providers. Methods to surpass these barriers might increase the use of formal preoperative risk analysis tools.
