De korte preoperatieve gezondheidsbeoordeling zoals voorgesteld door de gezondheidsraad in de praktijk niet bruikbaar

Objective. To evaluate the value of the short questionnaire drawn up by the Dutch Health Council for the classification of patients to an ASA class (a 5-point scale according to the American Society of Anesthesiologists, on which the patient's preoperative physical condition can be scored) and to propose an anaesthesia care plan for surgery patients aged between 16 to 40 years old. Design. Observational. Methods. From June 1999 through to May 2000, all 2090 preoperative patients aged 16 to 40 years at the academic hospital of Utrecht, the Netherlands, were asked to complete the Dutch Health Council's short questionnaire. In addition, the usual extensive preoperative health assessment was carried out on these patients. Of the 379 (18%) who were found by the short questionnaire to be 'healthy', 100 were selected. A panel of 10 anaesthesiologists was asked to preoperatively evaluate these 100 patients twice: once using the short questionnaire and once using the usual extensive health evaluation. The primary outcome was the percentage of patients who could be classified to an ASA class and for whom an anaesthesia care plan could be drawn up. The secondary outcome was the information judged by the anaesthesiologists to be either 'redundant' or 'missing' when drawing up an anaesthesia care plan. Results. Using the short questionnaire, 63% of the patients could not be assigned to an ASA class, compared to 22% with the extensive health evaluation (p < 0.0001). On the basis of the information obtained with the short questionnaire, it was not possible to draw up an anaesthesia care plan for any of the patients, while the extensive health evaluation enabled an anaesthesia care plan to be drawn up for 65% of the patients (95% CI: 62-68%). Using the missing information deemed 'necessary', recommendations were made for the minimum scope of a preoperative health assessment for use in patients aged 16 to 40 years old. Conclusion. The short questionnaire as proposed by the Dutch Health Council was not found to be useful in practice.