The Risk of Surgical Cancellation in Adult Patients Assessed by Telephone Versus In-person for Scheduled Non-cardiac Elective Surgery.

Universidad de Antioquia

Status: Not yet enrolling

Conditions: Postoperative Complications; Preanesthetic Medication; Risk Assessment; Surgical Procedures; Preoperative Care; Elective Surgery Cancellation; Noncardiac Surgery; Telemedicine; Anesthesia

Study type: Observational

Funder types: Other

Identifiers

NCT06693869

16-2024

Details and patient eligibility

About

Telemedicine has been regulated in Colombia since 2006, with applications in anesthesia being explored since 2004 to improve accessibility and reduce costs. Although Decree 538 of 2020 expanded telemedicine's medical applications, challenges such as connectivity issues and the need for training remain. Telemedicine has shown promise in rural areas of Colombia, particularly for managing chronic diseases. However, further evidence is needed regarding the effectiveness of telephone pre-anesthetic evaluations.

This study aims to investigate the implementation of telephone assessments for non-cardiac surgery and their impact on surgical cancellations compared to in-person pre-anesthetic evaluations. The primary question we seek to answer is:

Does telephone pre-anesthetic assessment in non-cardiac surgical patients carry a higher risk of surgical cancellations compared to in-person evaluations?

To address this question, we will evaluate patients' medical records in two hospitals where patients were assessed using both telephone and in-person modalities.

Full description

The COVID-19 pandemic accelerated the adoption of telemedicine, including its application in preoperative anesthesia evaluations. While the use of telephone assessments in anesthesiology is increasing, there is ongoing debate about their accuracy in identifying medical risks and predicting potential post-surgical outcomes. Preanesthetic evaluations are essential for determining patient suitability for surgery and for classifying surgical risk.

Despite the benefits of increased accessibility and cost reduction associated with telephone assessments, concerns persist regarding their ability to match the thoroughness of in-person evaluations. This is particularly relevant given the potential for higher surgical cancellation rates.

In Colombia, telephone preanesthetic evaluations for non-cardiac elective surgeries are a recent development, potentially optimising resource use and enhancing patient satisfaction. However, it is crucial to investigate whether they result in a cancellation rate comparable to in-person assessments, as this could be a significant barrier to widespread implementation. This study examines the effectiveness of telephone assessments for non-cardiac surgeries and their impact on surgical cancellations compared to in-person preanesthetic evaluations. A secondary objective of the study is to evaluate the incidence of perioperative complications, including cardiovascular issues, pulmonary complications, bleeding, unexpected ICU admissions, and non-anticipated difficult airways.

Enrollment: 1,180 estimated patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Patients who were scheduled for elective non-cardiac surgery.

Exclusion criteria

• Pregnant patients.
• More than three months between the pre-anesthetic evaluation and the scheduled surgery.

Trial design

1,180 participants in 2 patient groups

Telephone pre-anesthetic evaluation

Description:

Surgical patients scheduled for elective non-cardiac surgery underwent pre-anesthetic evaluation through a telephone consultation, which included a review of medical history, medications, and risk factors made by anesthesiologists. No physical examination was conducted.

In-Person pre-anesthetic evaluation

Description:

Surgical patients scheduled for elective non-cardiac surgery received an in-person pre-anesthetic evaluation performed by an anesthesiologist, which included a physical examination and a thorough risk assessment.