Teleconsultation compared with face-to-face consultation in the context of pre-anesthesia evaluation: TELANESTH, a randomized controlled single-blind non-inferiority study

Abstract

Study objective: During the COVID crisis, pre-anesthesia teleconsultations were widely used leading to savings in time and money. However, the non-inferiority of this system has not yet been evaluated. Design: Prospective, randomized, controlled, single-blind non-inferiority study. Setting: University hospital. Patients: Patients scheduled for surgery requiring a single pre-anesthesia consultation (PAC). Intervention: Pre-anesthesia teleconsultation (PATC) from patient's home. Measurements: Primary outcome: concordance between the pre-anesthesia visit (PAV), performed on the day of surgery, and PAC or PATC on: • ASA score (split into two groups: 1–2 and 3–4) • Mouth opening (separated into ≤35 mm or > 35 mm). • Pre-anesthesia medication reconciliation (expected therapeutic adjustments in anticoagulants, antiplatelet drugs, antihypertensives and antidiabetics). Secondary outcomes: cancellation rate, immediate perioperative complications, patient satisfaction, organization, and economic and ecological costs. Main results: Out of 172 patients included, 149 were analyzed. PATC was no less effective than PAC in terms of the primary outcome or each of its components: the difference between groups was: - 0.044[90% CI: −0.135; 0.047] (p = 0.0002). There was no difference in cancellation rates (PAC 1.99% vs. PATC 1.27%, p = 0.6) or in immediate perioperative complications (none). Satisfaction was 9.48 (±1.45) in the PAC group and 8.96 (±1.68) in the PATC group (p = 0.0006). In the PATC group, the mean savings per patient were 30 km (± 29), 36 min (± 27), and 18 (± 18) euros, respectively. Conclusions: According to our criteria, PATC was not inferior to PAC for preoperative patient evaluation and may be an interesting economical, ecological alternative.