Do Anesthesiologists Follow Belgian KCE Guidelines for Preoperative Evaluation?

Do Anesthesiologists Follow Belgian KCE Guidelines for Preoperative Evaluation in Patients Undergoing Non-emergency Surgery ?

For more than 50 years it has been shown that preoperative evaluations by anesthesiologists include too many unnecessary tests. Many of the tests ordered do not change the management of the patients. One example are preoperative coagulation tests which rarely give relevant information and can be omitted if the patients have a negative structured bleeding questionnaire. This situation has lead to the publication of many guidelines on preoperative evaluation, one of the most comprehensive being the 2022 guidelines by the European Society of Cardiology for the preoperative evaluation of cardiac patients undergoing non-cardiac surgery.

In Belgium, an independent center of experts, the Kenniscentrum - Centre d'Expertise (KCE) was created to give expert and independent opinions on healthcare related subjects. These recommendations are often used by Belgian authorities to guide public health law and determine which medical procedures or tests are covered by the social security.

The KCE has published an extensive guide on preoperative evaluation of patients undergoing non-cardiac surgery (KCE Reports 280Bs. D/2016/10.273/102.) These guidelines are freely available, either in print version, on the dedicated Website or as an App, and have been extensively spread in the anesthesiology community. Laboratory tests not recommended in these guidelines are not covered by the social security if no solid reason is given in the medical chart.

In this retrospective study, adherence to the KCE guidelines on preoperative evaluations will be evaluated in a tertiary University hospital. All patients, scheduled for elective surgery, will be included for a period of 3 month. For every patient the recommended tests will be determined and compared to the actual tests prescribed by the anesthesiologist during the preadmission visit.

Study Overview

• Status: Completed
• Conditions: Surgery
• Intervention / Treatment: Diagnostic test: Preop evaluation

• Study Type: Observational
• Enrollment (Actual): 2521

Contacts and Locations

Study Locations

• Belgium
  • Brussels, Belgium, 1070
    • Hopital Universitaire de Bruxelles - Hopital Erasme

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

All patients scheduled for elective surgery under general or locoregional anesthesia at Erasme University hospital seen at the anesthesiology preadmission clinic during Oct 1st 2022 and Dec 31st 2022

Description

Inclusion Criteria:

• All patients examined at the anesthesiology preadmission clinic during Oct 1st 2022 and december 31st 2022 and scheduled for elective surgery at Erasme University hospital under general or locoregional anesthesia

Exclusion Criteria:

• Non elective surgery
• Age < 18 years
• surgery under local anesthesia

Study Plan

How is the study designed?

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Adherence to KCE recommendations in percentage	Every tests prescribed in the anesthesiology preadmission clinic will be compared to the KCE recommendations. Each test will be classified as "appropriate" or "not recommended". The percentage of adherence to the KCE guidelines will be reported for each test.	24 hours

Collaborators and Investigators

• Sponsor: Erasme University Hospital

Study record dates

Study Major Dates

• Study Start (Actual): August 1, 2023
• Primary Completion (Actual): August 25, 2023
• Study Completion (Actual): August 29, 2023

Study Registration Dates

• First Submitted: March 28, 2023
• First Submitted That Met QC Criteria: March 28, 2023
• First Posted (Actual): April 7, 2023

Study Record Updates

• Last Update Posted (Actual): August 30, 2023
• Last Update Submitted That Met QC Criteria: August 29, 2023
• Last Verified: March 1, 2023

More Information

Terms related to this study

• Other Study ID Numbers: SRB2023061

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No