What do general medicine perioperative services do? A Victorian multicentre cross-sectional study.

AIM: To evaluate the models of general medicine perioperative services and describe the characteristics and outcomes of perioperative referrals.

METHODS

A multicentre cross-sectional study involving 11 Victorian public hospitals was conducted over 6 weeks at each site. Adult patient (≥18 years old) referrals from all surgical services were included. Comparative analyses of outcomes based on models of care were undertaken and adjusted for covariates.

RESULTS

The overall service activity was 427 (95% CI: 403-453) referrals per 10 000 surgical admissions per year. Of 1071 referrals, 922 (86.1%) were inpatients and 759 (70.9%) were emergency instances. Median age was 73 (62-83) years and 45.5% were females. Median Charlson Comorbidity Index was 5 (3-6) and clinical frailty scale was 4 (3-5). The most common referral requests were for preoperative risk assessment and optimisation, management of postoperative medical complications and diagnostic input. Clinical outcomes included 43 (4.3%) deaths, 73 (7.9%) medical emergency team (MET) responses and 32 (3.5%) intensive care admissions within 48 h and 116 (11.6%) take-over of care instances. Proactive model of care was significantly associated with fewer MET calls, shorter length of stay, fewer referrals to other subspecialties and take-over of care and higher rates of returning to usual residence. Lower likelihood of MET calls, referral to other subspecialties and take-over of care remained statistically significant in multivariable analyses.

CONCLUSIONS

General medicine perioperative services provide care to older, co-morbid, frail and high-risk surgical patients across all perioperative settings. General physicians' role in perioperative care is diverse and wide-ranging. Well-resourced proactive models of perioperative care may confer better outcomes for patients.