Teleconsultation compared with face-to-face consultation in the context of pre-anesthesia evaluation: TELANESTH, a randomized controlled single-blind non-inferiority study - 20/11/23
, Thierry Chevallier, PhD b, Chris Serrand, MD b, Mikael Perin, MD a, Yann Gricourt, MD a, Philippe Cuvillon, PhD aAbstract |
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.
Le texte complet de cet article est disponible en PDF.Highlights |
• | Remote consultation seems as reliable as face-to-face one regarding physical status, intubation criteria or medication conciliation. |
• | Technical problems are the main factor limiting patient satisfaction during remote consultation. |
• | Remote consultation leads to substantial savings in cost and energy. |
Keywords : Perioperative, Telemedicine, Telehealth, Teleconsultation, Remote consultation, Pre-anesthesia evaluation, Anesthesia, Tele-anesthesia
Plan
Vol 92
Article 111318- février 2024 Retour au numéro
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