Strategies to improve preoperative care

The contents and organization of the preoperative care have gained increasing attention over the past decade. Several strategies have emerged to evaluate and optimize patients before surgery, aiming to minimize the risk of complications. In this thesis two different strategies for preoperative evaluation and optimization were studied: outpatient preoperative evaluation clinics (OPE clinics) and preoperative interventions embedded in clinical pathways for gastrointestinal surgery. At an OPE clinic the anaesthetist timely evaluates the preoperative condition of patients to asses the risk on complications during and after surgery. Formerly, this evaluation was performed by internists and surgeons or by the anaesthetist just before he started anaesthesia. The implementation of OPE clinics was evaluated by a nationwide survey with questionnaires. Cooperation of anaesthetists was most frequently mentioned as facilitating factor for implementation of OPE clinics. Lack of finance was most frequently reported as limiting factor, but significantly more often in hospitals without than in with an OPE clinic (