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Editor's Correspondence
July 14, 2008

Opportunity Realized? Medical Consultation for Patients Undergoing Major Surgery

Arch Intern Med. 2008;168(13):1470-1471. doi:10.1001/archinte.168.13.1470-c

Auerbach et al1 presented a retrospective analysis of patients who underwent surgery. The use of perioperative consultation in this population was not associated with differences in the administration of β-blockers, use of thromboprophylaxis, or glycemic control. They concluded that that “[P]erioperative internal medicine consultation produces inconsistent effects on . . . quality of care . . . .”1(p2338) It seems overreaching to draw such a conclusion and generalization from an observational study at 1 institution that did not match patients by morbidity or type of surgery and could have used a better reference group. Their study was conducted after the playing field was altered by an internist-championed educational program and implementation of perioperative order sets. It seems likely that the authors measured the efficacy of the program and not the quality of care. It would have been more informative to see data from the preeducational and posteducational eras.