Does Nurse-Led Pre-operative Assessment Reduce the Cancellation Rate of Elective Surgical In-Patient Procedures?: A Systematic Review of the Research Literature

Pre-operative assessment (POA) has been advocated for use to achieve a number of goals including reducing cancelled operations on the day of surgery, and therefore waiting lists. POA has historically been provided by junior doctors, but the change in focus of their role in addition to the new roles being taken on by nurses has led to nurse-led POA. The aim of this review was to determine whether nurse-led POA reduces the cancellation rate of elective surgical in-patient procedures. The Cochrane Library, Medline, Cinahl and Embase databases were searched for systematic reviews, randomised control trials and cohort studies examining nurse-led POA. After applying inclusion criteria only four cohort studies were deemed to be suitable to be critically appraised. One study had no cancellations in either the doctor or nurse-led POA groups. Another study had low cancellation rates in the nurse-led POA group, but the control group was not suitably defined for adequate verification as to whether the cancellation rates were lower because they had been pre-assessed. The final two studies revealed similar absolute risk reductions, number needed to treat and odds ratios. In summary nurse-led POA appears to reduce cancellation rates on admission, but the evidence for this is relatively weak, primarily because study samples have been small. Further trials are needed which have samples that are sufficient to detect a true difference between the intervention and control group if one exists.