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Table 2 Themes related to benefits and harms of preoperative medical evaluation

From: Surgeons’ views on preoperative medical evaluation: a qualitative study

Theme Number of interviews supporting theme, representative quote Number of interviews opposing theme, representative quote
The preoperative medical evaluation can improve surgical outcomes by identifying treatable occult conditions and/or optimizing chronic conditions. 12 interviews “I think it prevents catastrophes. I mean, you wouldn’t want to carry someone to the operating room and have the stress test on the operating room table. But by doing a preoperative evaluation you might uncover, whether it’s the EKG, whether it’s laboratory findings, you might uncover something that suggests this person is at high risk for cardiovascular disease which might lead to other evaluation which could prevent a misadventure, so to speak, in the operating room.” -Academic urologic surgeon 2 interviews “I mean if you believe the trials, you know, the CARP trial being the classic one, there is no benefit for preoperative evaluation.” -Academic vascular surgeon
Many patients do not medically benefit from the preoperative medical evaluation 8 interviews “How many pre-ops do you have to do before you find something really wrong? Because most people, you are not going to find anything in that kind of situation.” -Private practice colorectal surgeon 0 interviews
A normal preoperative medical evaluation before surgery is reassuring to patients and physicians 6 interviews “There is a peace of mind I get from it, because if I have those numbers and objective data in front of me then it makes me feel more confident that the patient is going to be safe.” -Academic endocrine surgeon 0 interviews
The preoperative medical evaluation has minimal to no medical risk for patients 12 interviews “I don’t see an overt downside to a preoperative evaluation other than the logistics of it, frankly.” -Academic vascular surgeon 2 interviews “It’s sort of like screening for most conditions, where if they’re not symptomatic and you find something, you are forced- you’re not forced, but the standard of care at that point is to pursue it, and sometimes that even postpones surgery because something has been discovered that may or may not be clinically important, and so I think it’s just a lot of extra engagement with the health care system.” -Academic otolaryngologic surgeon
Additional office visits and tests can be an inconvenience for patients 16 interviews “It’s cumbersome. I mean it’s difficult. They have to come back on a separate day. A lot of my out-of-towners, it’s difficult, right, because let’s say you live in Kansas and you are coming here for surgery and you see me and we schedule surgery. You go home and see your family, and now you’ve got to come back a couple of days before the surgery to go to the [preoperative clinic]. And so it’s an inconvenience for sure.” -Academic oncologic surgeon 1 interviews “But, interestingly enough, the patients accept it very willingly. Almost expected, not just accepted.” -Academic colorectal surgeon
The financial cost to the patient and/or healthcare system is a downside of the preoperative medical evaluation. 14 interviews “It’s expensive and most of it is not necessary. And it’s expensive both from the standpoint of true monetary cost of doing testing but also there’s a time expense for everybody.” -Academic endocrine surgeon 3 interviews “And I think there is a benefit in that if you can prevent a complication, there is a huge benefit not only clinically, but also financially.” -Academic oncologic surgeon