Effects of Screening by Consultants on Recommended Elective Surgical Procedures

Abstract

To assess the need for elective operations recommended to a group of union members, 1356 self-selected patients were re-examined by board-certified specialists. Approximately 24 per cent of all procedures recommended were not confirmed. An additional 2.1 per cent were confirmed but did not require hospitalization. The proportion of cases not confirmed in each of the surgical specialties were as follows, in descending order of frequency of utilization: general surgery, 16.4 per cent; gynecology, 31.4 per cent; orthopedics, 40.3 per cent; ear, nose and throat, 16.3 per cent; ophthalmology, 28.2 per cent; and urology, 35.8 per cent. Program operating costs were about one eighth of the estimated savings from hospitalizations not required. Because of the cost savings and the demonstrated percentage of operations not approved, presurgical screening programs appear to have a substantial benefit for any insured population. (N Engl J Med 291:1331–1335, 1974)