NEW ORLEANS — Nurse-practitioner led preoperative care can reduce surgical cancellation rates by increasing the number of patients medically optimized for surgery and may provide additional revenue for surgical practices, according to a speaker here.

“Nurse practitioners are well poised to lead interdisciplinary teams to improve preoperative care coordination,” said Aaron Sebach, DNP, MBA, FNP-BC, at the American Association of Nurse Practitioners 2015 meeting

Preoperative care is often uncoordinated and lacks standardization, which can lead to unnecessary surgical delays, cancellations, and increased healthcare spending. 

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However, the idea of establishing preoperative evaluation clinics to facilitate timely preoperative evaluations and ancillary testing in one convenient location has been around for nearly 20 years, according to Sebach. 

To determine the effectiveness of a NP-managed preoperative evaluation clinic at a large multi specialty orthopedic practice in Maryland, Sebach and colleagues compared surgical cancellation and missed revenue outcomes in a convenience sample of 121 patients undergoing surgical procedures performed from Oct. to Dec. 2014 with a 571 patients who underwent standard formal preoperative clearance, and 450 patients evaluated by a primary care provider. 

The NP-led preoperative evaluation consisted of: testing and onsite xrays based on evidence-based practice guidelines; a 45-minute NP evaluation; additional testing and specialist referrals as necessary; and NP-made surgical clearance decision. Follow-up with real-time care coordination between the patient, NP, surgeon, and surgical coordinator was ongoing.

The patients in the NP-led clinic had just a single cancellation resulting in $4,276 in lost revenue compared with 36 cancellations and $184,480 of missed revenue in the standard care group, and 35 cancellations and $180,204 of missed revenue in the primary care group (P<0.01), the researchers found. 

“Surgical practices should consider the addition of NPs to coordinate preoperative care,” Sebach said. “Offering preoperative testing and evaluations in one convenient location  will further reduce surgical cancellation rates.”


  1. Sebach A et al. Poster Session. “Development of a Nurse Practitioner-Managed Preoperative Evaluation Clinic Within a Multispecialty Orthopedic Practice.” Presented at: AANP 2015. June 10-14; New Orleans.