Table 3 Themes related to risk assessment
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 |
|---|---|---|
Surgeons are confident in their ability to assess patients’ surgical risk. | 13 interviews “I think we get a good gestalt of the patients overall by the time you get through the H&P. The longest assessment is the initial visit. Once you can confirm their medical history and the medications you get a good sense of their risk.” -Academic orthopedic surgeon | 5 interviews “I don’t really have the expertise to figure out their cardiac risk whereas the other providers generally do… I mean, qualitatively I can tell. Some patients are probably going to be higher risk than others, but beyond that I’m not really trained in what to specifically look for.” -Private practice orthopedic surgeon |
The risk assessment provided by non-surgeons is viewed primarily as either clearing or not clearing the patient for surgery. | 11 interviews “I’ll generally make sure there’s no glaringly abnormal laboratory studies and make sure at least the note from PCP says the patient is cleared for surgery or moderate—make sure it doesn’t say they’re at extremely high risk or really not cleared for surgery. If that were the case, then they probably would have notified me beforehand, so I’m not going to read [the note] in detail.” -Private practice orthopedic surgeon | 4 interviews “If I was about to do a big operation on someone and the preop says, “whoa, whoa, whoa, hold on, this is a really sick person,” sometimes there’s a lesser option. If they uncover things that I wasn’t aware of, I might go with, for obstructing colon cancer, I might go with a stoma. Just give them a bag, a quick operation, rather than trying to take it out and do this five hour operation.” -Academic colorectal surgeon |