Alternatives to the in-person anaesthetist-led preoperative assessment in adults undergoing low-risk or intermediate-risk surgery

Abstract

BACKGROUNDThe design of the optimal preoperative evaluation is a much debated topic, with the anaesthetist-led in-person evaluation being most widely used. This approach is possibly leading to overuse of a valuable resource, especially in low-risk patients. Without compromising patient safety, we hypothesised that not all patients would require this type of elaborate evaluation.OBJECTIVEThe current scoping review aims to critically appraise the range and nature of the existing literature investigating alternatives to the anaesthetist-led preoperative evaluation and their impact on outcomes, to inform future knowledge translation and ultimately improve perioperative clinical practice.DESIGNA scoping review of the available literature.DATA SOURCESEmbase, Medline, Web-of-Science, Cochrane Library and Google Scholar. No date restriction was used.ELIGIBILITY CRITERIAStudies in patients scheduled for elective low-risk or intermediate-risk surgery, which compared anaesthetist-led in-person preoperative evaluation with non-anaesthetist-led preoperative evaluation or no outpatient evaluation. The focus was on outcomes, including surgical cancellation, perioperative complications, patient satisfaction and costs.RESULTSTwenty-six studies with a total of 361 719 patients were included, reporting on various interventions: telephone evaluation, telemedicine evaluation, evaluation by questionnaire, surgeon-led evaluation, nurse-led evaluation, other types of evaluation and no evaluation up to the day of surgery. Most studies were conducted in the United States and were either pre/post or one group post-test-only studies, with only two randomised controlled trials. Studies differed largely in outcome measures and were of moderate quality overall.CONCLUSIONSA number of alternatives to the anaesthetists-led in-person preoperative evaluation have already been researched: that is telephone evaluation, telemedicine evaluation, evaluation by questionnaire and nurse-led evaluation. However, more high-quality research is needed to assess viability in terms of intraoperative or early postoperative complications, surgical cancellation, costs, and patient satisfaction in the form of Patient-Reported Outcome Measures and Patient-Reported Experience Measures.

Alternatives to the in-person anaesthetist-led preoperative assessment in adults undergoing low-risk or intermediate-risk surgery. A scoping review: putting an end to ‘semper idem’

“…We read with interest the study by Jonker et al entitled ‘Alternatives to the in-person anaesthetist-led preoperative assessment in adults undergoing low-risk or intermediate-risk surgery. A scoping review’ 1 . We congratulate the authors on this large-scale review comparing different alternatives to in-person preoperative visits regarding case cancellations, complications, financial burden or patient satisfaction.…”

“…None of the older studies truly assessed patient satisfaction, one of the outcome parameters mentioned in Jonker et al . 's study 1 …”

“…A scoping review’. 1 We congratulate the authors on this large-scale review comparing different alternatives to in-person preoperative visits regarding case cancellations, complications, financial burden or patient satisfaction. The authors argue, that regarding the outcome parameters mentioned above, a simple digital questionnaire represents an effective method for the preoperative assessment.…”

“…Second, as one of the cited studies in favour of the questionnaire-format from 1997 already stated, patient satisfaction needs to be assessed for sound evaluations of effectiveness and efficiency of preanaesthesia clinics. 1 …”

Improving patient care and enhancing surgical efficiency: strategies to reduce same‐day surgical cancellations

“…Before implementation of the intervention, patients undergoing surgery would be risk‐stratified by the surgeon and then would either be scheduled for a telehealth appointment with an anaesthetist or nurse practitioner, or would be scheduled for an in‐person pre‐operative internal medicine office visit. Other hospital systems that already have anaesthetist‐directed pre‐operative evaluations for all patients in the days to weeks before surgery – as is becoming more common worldwide, particularly as patients become more medically complex [12, 13] – may not see the same magnitude of effect from the type of intervention tested in this study. Third, while the study evaluated the potential savings of the bundle, it did not evaluate the costs of implementation.…”