A Population-Based Study of Anesthesia Consultation Before Major Noncardiac Surgery
Bibliographic record
Abstract
BACKGROUND: In single-center studies, consultation by an anesthesiologist days to weeks before surgery was associated with reduced patient anxiety, case cancellations on the day of surgery, and duration of hospitalization. Nonetheless, the impact of anesthesia consultation on outcomes in the population remains unclear. METHODS: We used population-based, linked, administrative databases to conduct a cohort study of patients, aged 40 years and older, who underwent selected elective intermediate- to high-risk noncardiac surgical procedures in Ontario, Canada, between April 1, 1994, and March 31, 2004. Propensity-score methods were used to construct a matched-pairs cohort that resolved important differences between patients who underwent consultation and those who did not. We then determined the association of consultation (within 60 days before surgery) with hospital length of stay and postoperative mortality (30-day and 1-year) rates within the matched pairs. RESULTS: Of the 271 082 patients in the entire cohort, 39% (n = 104 716) underwent anesthesia consultation. The proportion of patients who underwent consultation increased from 19% in 1994 to 53% in 2003. Within the matched-pairs (n = 180 254), consultation was associated with reduced mean hospital length of stay (8.17 days vs 8.52 days; difference, -0.35 days; 95% confidence interval [CI], -0.27 to -0.43; P < .001). Consultation was not associated with reduced mortality at 30 days (relative risk, 1.04; 95% CI, 0.96 to 1.13; P = .36) or 1 year (relative risk, 0.98; 95% CI, 0.95 to 1.02; P = .20). CONCLUSIONS: Preoperative anesthesia consultation is associated with reduced length of stay but not with reduced mortality. Future research should evaluate the cost-effectiveness of the increasing use of anesthesia consultation.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".