Virtual preoperative assessment in surgical patients: A systematic review and meta-analysis

Zhang, Kevin; Rashid-Kolvear, Matin; Waseem, Rida; Englesakis, Marina; Chung, Frances

STUDY OBJECTIVE: Preoperative assessment is a standard evaluation, traditionally done in-person in a preanesthesia clinic, for patients who will be undergoing a procedure involving anesthesia. Given the increased adoption of virtual care during the coronavirus disease 2019 (COVID-19) pandemic, the purpose of this systematic review and meta-analysis is to review the effectiveness of virtual preoperative assessment for the evaluation of surgical patients. DESIGN: Systematic review and meta-analysis. SETTING: MEDLINE (Ovid), MEDLINE InProcess/ePubs, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and ClinicalTrials.gov were searched from the initial coverage of the respective database to May 2021. A manual citation search of Google Scholar and PubMed was conducted to identify missed articles. Continued literature surveillance was done through July 2021. PATIENTS: Patients aged 18 years and older undergoing virtual preoperative anesthesia assessment. INTERVENTIONS: Virtual preoperative assessment. MEASUREMENTS: Surgery cancellation rates, patient experience, resources saved, staff experience, success in using the data collected to diagnose and manage patients. MAIN RESULTS: Fifteen studies (n = 31,496 patients) were included in this review. The average age of patients was 58 ± 15 years, and 47% were male. Virtual preoperative assessment resulted in similar surgery cancellation rates compared to in-person evaluation, with a pooled cancellation rate of 2% (95% confidence interval [CI]: 1-3%). Most studies reported a positive patient experience, with a pooled estimate of 90% (95% CI, 81-95%). There was a high success rate in using the information collected with virtual care, in the range of 92-100%, to diagnose and manage patients resulting in time and cost savings in the range of 24-137 min and $60-67 per patient. CONCLUSIONS: This systematic review and meta-analysis demonstrates the utility of virtual care for preoperative assessment of surgical patients. Virtual preanesthesia evaluation had similar surgery cancellation rates, high patient satisfaction, and reduced costs compared to in-person evaluation.