Preoperative internal medicine evaluation is associated with a reduction in 30-Day postoperative mortality risk in patients with cancer

Tacara N. Soones, Anna Guo, Jessica T. Foreman, Cheuk Hong Leung, Heather Y. Lin, Shannon Popovich, Sunil K. Sahai, Jessica P. Hwang

Research output: Contribution to journalArticlepeer-review


Background: Patients commonly undergo evaluation by internists prior to surgery. However, the impact of preoperative internal medicine evaluations on the postoperative outcomes of patients with cancer is uncertain. Methods: We conducted a retrospective cohort study of patients who had been included in the National Surgery Quality Improvement Program from 2011 to 2014 from a single hospital specializing in cancer care to determine the effect of an Internal Medicine Perioperative Assessment Center (IMPAC) evaluation (IMPAC group) on the risk of 30-day mortality compared to that of patients who proceeded directly to surgery (control group). Results: Of the 11,577 participants, 3,589 underwent an IMPAC evaluation. The absolute 30-day mortality was 0.47% for the IMPAC group and 0.50% for the control group. After propensity matching, the odds ratio (OR) of 30-day mortality was 0.39 (95% CI=0.18–0.84) for the IMPAC group in comparison to the control group. Conclusions: Our findings demonstrate that a preoperative internal medicine evaluation was associated with lower 30-day mortality. Additional studies are needed to identify which patient populations are most likely to benefit and which attributes of the internal medicine evaluation are most beneficial.

Original languageEnglish (US)
Article number100240
JournalPerioperative Care and Operating Room Management
StatePublished - Mar 2022


  • ASA, American society of anesthesiology
  • Abbreviations: ACS NSQIP, American college of surgeons national surgery quality improvement program
  • BMI, Body mass index
  • COPD, Chronic obstructive pulmonary disease
  • Cancer
  • FG/HPB, foregut and hepatopancreatobiliary
  • GBAAS, gallbladder, appendix, adrenals, or spleen
  • IMPAC, Internal Medicine Perioperative Assessment Center
  • Postoperative mortality
  • Preoperative care
  • SIRS, systemic inflammatory response syndrome
  • Surgical oncology

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine
  • Medical–Surgical
  • Anesthesiology and Pain Medicine


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