van den Blink Aneya, Janssen Liedewij M J, Hermanides Jeroen, Loer Stephan A, Straat Fidessa K, Jessurun Estaban N, Schwarte Lothar A, Schober Patrick
Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Anesthesiology, De Boelelaan 1117, Amsterdam, the Netherlands.
Amsterdam UMC location University of Amsterdam, Department of Anesthesiology, Meibergdreef 9, Amsterdam, the Netherlands.
J Clin Anesth. 2022 Nov;82:110941. doi: 10.1016/j.jclinane.2022.110941. Epub 2022 Aug 5.
Rising patient numbers, with increasing complexity, challenge the sustainability of the current preoperative process. We evaluated whether an electronic screening application can distinguish patients that need a preoperative consultation from low-risk patients that can be first seen on the day of surgery.
Prospective cohort study.
Preoperative clinic of a tertiary academic hospital.
1395 adult patients scheduled for surgery or procedural sedation.
We assessed a novel electronic preoperative screening application which consists of a questionnaire with a maximum of 185 questions regarding the patient's medical history and current state of health. The application provides an extensive health report, including an American Society of Anesthesiologists physical status (ASA-PS) classification and a recommendation for either consultation by an anesthesiologist at the preoperative clinic or approval for screening on the day of surgery.
The recommendation of the electronic screening system was compared with the regular preoperative assessment using measures of diagnostic accuracy and agreement. Secondary outcomes included ASA-PS classification, patient satisfaction, and the anesthesiologists' opinion on the completeness and quality of the screening report.
Sensitivity to detect patients who needed additional consultation was 97.5% (95%CI 91.2-99.7) and the negative likelihood ratio was 0.08 (95%CI 0.02-0.32). 407 (29.2%) patients were approved for surgery by both electronic screening and anesthesiologist. In 909 (65.2%) cases, the electronic screening system recommended further consultation while the anesthesiologist approved the patient (specificity 30.9% (95%CI 28.4-33.5); poor level of agreement (ĸ = 0.04)). Agreement regarding ASA-PS classification scores was weak (ĸ = 0.48). The majority of patients (78.0%) felt positive about electronic screening replacing the regular preoperative assessment.
Electronic screening can reliably identify patients who can have their first contact with an anesthesiologist on the day of surgery, potentially allowing a major proportion of patients to safely bypass the preoperative clinic.
患者数量不断增加且病情日益复杂，对当前术前流程的可持续性构成挑战。我们评估了一种电子筛查应用程序能否区分需要术前会诊的患者与可在手术当天首次就诊的低风险患者。
前瞻性队列研究。
一家三级学术医院的术前诊所。
1395例计划接受手术或程序镇静的成年患者。
我们评估了一种新型电子术前筛查应用程序，该程序包含一份问卷，最多有185个关于患者病史和当前健康状况的问题。该应用程序提供一份详尽的健康报告，包括美国麻醉医师协会身体状况（ASA-PS）分类，以及关于在术前诊所由麻醉医师会诊或批准在手术当天进行筛查的建议。
使用诊断准确性和一致性指标，将电子筛查系统的建议与常规术前评估进行比较。次要结果包括ASA-PS分类、患者满意度，以及麻醉医师对筛查报告完整性和质量的意见。
检测需要额外会诊患者的敏感性为97.5%（95%置信区间91.2 - 99.7），阴性似然比为0.08（95%置信区间0.02 - 0.32）。407例（29.2%）患者经电子筛查和麻醉医师均批准可进行手术。在909例（65.2%）病例中，电子筛查系统建议进一步会诊，而麻醉医师批准了该患者（特异性30.9%（95%置信区间28.4 - 33.5）；一致性水平较差（ĸ = 0.04））。关于ASA-PS分类评分的一致性较弱（ĸ = 0.48）。大多数患者（78.0%）对电子筛查取代常规术前评估持积极态度。
电子筛查能够可靠地识别可在手术当天首次与麻醉医师接触的患者，这可能使很大一部分患者安全绕过术前诊所。
