Teleconsultations Compared to In-Person Consultations in Pre-Anesthetic Evaluation: a Systematic Review with Meta-Analysis and Trial Sequential Analysis of Randomized Clinical Trials
DOI:
https://doi.org/10.36557/2674-9432.2026v5n5p650-666Keywords:
Telemedicine, Perioperative Care, AnesthesiologyAbstract
Background: Telemedicine has emerged as a potential alternative to conventional in-person pre-anesthetic evaluation (PAE), but its effectiveness and acceptability remain uncertain. This systematic review with meta-analysis and trial sequential analysis (TSA) compared teleconsultations (TC) with in-person consultations (IPC) in adults undergoing PAE.
Methods: This review followed PRISMA 2020 guidelines and was prospectively registered in PROSPERO (CRD420251129363). MEDLINE, EMBASE, and Cochrane CENTRAL were searched from inception to July 2025 for randomized controlled trials comparing TC with IPC before elective surgical or diagnostic procedures. The primary outcome was patient satisfaction. Secondary outcomes included American Society of Anesthesiologists (ASA) physical status reclassification, preoperative anxiety, and surgical cancellation. Risk of bias was assessed using RoB 2 and certainty of evidence with GRADE. Random-effects meta-analyses estimated Hedges’ g and risk ratios (RR). TSA assessed the robustness of cumulative evidence.
Results: Five randomized controlled trials involving 1,151 patients were included. Patient satisfaction was significantly higher with IPC (Hedges’ g −0.26; 95% CI −0.43 to −0.08; p = 0.0047). No significant differences were observed for ASA physical status reclassification (RR 1.14; 95% CI 0.41–3.13), surgical cancellation (RR 0.59; 95% CI 0.23–1.48), or preoperative anxiety (Hedges’ g 0.07; 95% CI −0.13 to 0.28). Heterogeneity was low across most analyses. TSA showed that accrued information reached only 9.8–45.4% of the required sample size, indicating insufficient evidence for secondary outcomes. Evidence certainty was moderate for satisfaction and ASA reclassification and low for the remaining outcomes.
Conclusions: IPC was associated with greater patient satisfaction than TC, while current evidence does not demonstrate meaningful differences in operative risk classification, preoperative anxiety, or surgical cancellation. IPC should remain the reference standard until adequately powered trials provide more definitive evidence.
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