Preadmission clinics drive better surgical outcomes, lower costs, fewer cancellations

Editor's Note

Preadmission clinics (PACs) are supporting perioperative care by reducing complications, shortening hospital stays, and improving surgical outcomes—particularly for high-risk patients. As detailed in the April 2025 edition of ASA Monitor from the American Society of Anesthesiologists (ASA), PACs operate as multidisciplinary outpatient hubs where medical optimization, risk assessment, and patient education converge well ahead of surgery, leading to fewer day-of cancellations and smoother recoveries.

The article outlines how PACs address surgical risks early through detailed medical histories, targeted testing, and specialist consultations. High-risk patients—those with cardiovascular, respiratory, or metabolic conditions—benefit most from this tailored approach. Studies cited in the article show that PAC interventions significantly cut medical cancellations (from 2% to 0.9%) and reduce hospital stays (from 6.2 to 5 days), while even lowering surgical mortality in orthopedic cases from 6.1% to 1.2%.

Beyond logistics, PACs also play a critical role in addressing frailty and malnutrition—two key predictors of poor postoperative outcomes. The article notes that screening tools like the FRAIL scale and the Edmonton Frail Scale should be universally applied, as frailty is not limited to older adults. PACs also offer a structured environment for nuanced discussions about advance directives, including do-not-resuscitate (DNR) orders.

From a systems perspective, PACs deliver clear cost savings. One study cited reports a $463 reduction in preoperative costs per patient. Streamlined electronic health record workflows, telemedicine options for low-risk patients, and continuous quality improvement strategies further bolster operational efficiency. PACs are not just a logistical solution, but an essential clinical strategy, the article concludes. By enabling early risk identification and comprehensive care planning, PACs stand as a cornerstone of modern surgical care, particularly as healthcare systems increasingly prioritize safety, cost control, and patient satisfaction.