Effect of perioperative evaluation and consultation on cost and outcome of surgical care.

The preoperative evaluation has traditionally focused on identifying the subset of patients for whom further testing would identify patients at increased risk. The past decade has seen a reorientation to focus on developing systems, both guidelines and preoperative evaluation clinics, that can reduce the number of unindicated testing and more appropriately direct the preoperative evaluation as a means of reducing costs. In patients who are at risk for cardiac disease administrative data-sets have been used to link perioperative interventions with outcome. Future research must be directed at proving effectiveness in randomized clinical trials.