Teleconsultation Versus In-Person Pre-Anesthetic Evaluation

Key Takeaways

• In-person consultation was associated with higher patient satisfaction than teleconsultation in pooled randomized evidence.
• ASA physical status reclassification, surgical cancellation, and preoperative anxiety did not differ significantly between groups.
• Trial sequential analysis suggested the secondary outcomes remained underpowered, with moderate certainty for satisfaction and ASA reclassification and low certainty for the remaining outcomes.

Pooled randomized evidence from five trials involving 1,151 adults undergoing pre-anesthetic evaluation found higher patient satisfaction with in-person consultation than teleconsultation. In the reviewed comparison of teleconsultation versus in-person pre-anesthetic evaluation, other measured outcomes, including ASA physical status reclassification and preoperative anxiety, did not differ significantly between groups. The trials included adults preparing for elective surgical or diagnostic procedures, where pre-anesthetic assessment informs perioperative planning and patient experience. Overall, the reviewed trials showed a clearer difference in satisfaction than in the other measured outcomes.

The investigators conducted a systematic review with meta-analysis and trial sequential analysis of randomized controlled trials in adults undergoing pre-anesthetic evaluation before elective procedures. Teleconsultation was compared with in-person consultation before elective surgical or diagnostic procedures, with patient satisfaction as the primary outcome. Secondary outcomes included ASA physical status reclassification, preoperative anxiety, and surgical cancellation. The review followed PRISMA 2020 and PROSPERO registration CRD420251129363, searched MEDLINE, EMBASE, and Cochrane CENTRAL through July 2025, used RoB 2, and pooled random-effects estimates.

In the pooled analysis, patient satisfaction favored in-person consultation with Hedges' g −0.26, 95% CI −0.43 to −0.08, and p = 0.0047. ASA physical status reclassification showed RR 1.14 with 95% CI 0.41 to 3.13, indicating no significant difference between groups. Surgical cancellation showed RR 0.59 with 95% CI 0.23 to 1.48, and preoperative anxiety showed Hedges' g 0.07 with 95% CI −0.13 to 0.28. No significant differences were seen in those secondary outcomes. Heterogeneity was low across most analyses.

The trial sequential analysis found that accrued information reached only 9.8% to 45.4% of the required sample size. The cumulative evidence for secondary outcomes therefore remained underpowered despite the randomized trial data. Certainty was rated as moderate for satisfaction and ASA physical status reclassification and low for preoperative anxiety and surgical cancellation. This left firmer support for the satisfaction finding than for the other measured outcomes in this evidence base. In the authors' framing, in-person consultation remained the reference standard until adequately powered trials provide more definitive evidence.