Comparación entre teleconsultas y consultas presenciales en la evaluación preanestésica: revisión sistemática con metaanálisis y análisis secuencial de ensayos clínicos aleatorizados
DOI:
https://doi.org/10.36557/2674-9432.2026v5n5p650-666Palabras clave:
Telemedicina, Atención Perioperatoria, AnestesiologíaResumen
Introducción: La telemedicina ha surgido como una alternativa potencial a la evaluación preanestésica (EPA) presencial convencional; sin embargo, su eficacia y aceptabilidad siguen siendo inciertas. Esta revisión sistemática con metaanálisis y análisis secuencial de ensayos (Trial Sequential Analysis, TSA) comparó las teleconsultas (TC) con las consultas presenciales (CP) en adultos sometidos a una EPA.
Métodos: Esta revisión siguió las directrices PRISMA 2020 y fue registrada prospectivamente en PROSPERO (CRD420251129363). Se realizaron búsquedas en MEDLINE, EMBASE y Cochrane CENTRAL desde su creación hasta julio de 2025 para identificar ensayos clínicos aleatorizados que compararan TC con CP antes de procedimientos quirúrgicos o diagnósticos electivos. El desenlace primario fue la satisfacción del paciente. Los desenlaces secundarios incluyeron la reclasificación del estado físico según la American Society of Anesthesiologists (ASA), la ansiedad preoperatoria y la cancelación de cirugías. El riesgo de sesgo se evaluó mediante la herramienta RoB 2 y la certeza de la evidencia mediante el sistema GRADE. Los metaanálisis de efectos aleatorios estimaron el tamaño del efecto de Hedges (g) y los riesgos relativos (RR). El TSA evaluó la solidez de la evidencia acumulada.
Resultados: Se incluyeron cinco ensayos clínicos aleatorizados con un total de 1.151 pacientes. La satisfacción de los pacientes fue significativamente mayor en el grupo de CP (g de Hedges −0,26; IC del 95%: −0,43 a −0,08; p = 0,0047). No se observaron diferencias significativas entre ambas modalidades de consulta en la reclasificación del estado físico ASA (RR 1,14; IC del 95%: 0,41–3,13), la cancelación de cirugías (RR 0,59; IC del 95%: 0,23–1,48) ni la ansiedad preoperatoria (g de Hedges 0,07; IC del 95%: −0,13 a 0,28). La heterogeneidad fue baja en la mayoría de los análisis. El TSA mostró que la información acumulada alcanzó solo el 9,8–45,4% del tamaño muestral requerido, lo que indica evidencia insuficiente para los desenlaces secundarios. La certeza de la evidencia fue moderada para la satisfacción y la reclasificación ASA, y baja para los demás desenlaces.
Conclusiones: La consulta presencial se asoció con una mayor satisfacción de los pacientes que la teleconsulta, mientras que la evidencia actual no demuestra diferencias clínicamente relevantes en la clasificación del riesgo operatorio, la ansiedad preoperatoria ni la cancelación de cirugías. La consulta presencial debe mantenerse como el estándar de referencia hasta que ensayos clínicos con un tamaño muestral adecuado proporcionen evidencia más concluyente.
Palabras clave: Telemedicina; Atención Perioperatoria; Anestesiología.
Descargas
Citas
[1] American Society of Anesthesiologists. Practice advisory for preanesthesia evaluation. Anesthesiology. 2012;116(3):522–538. https://doi.org/10.1097/ALN.0b013e31823c1067.
[2] World Health Organization. A health telematics policy in support of WHO’s health-for-all strategy for global health development. Geneva: World Health Organization; 1998.
[3] D. Srivastava, S.L. Solanki, S. Ambasta, A. Chandra. Tele-Preanesthetic check-ups (TelePAC) during COVID-19: Apprehensions and possibilities. J Anaesthesiol Clin Pharmacol. 2020;36(3):415-417. https://doi.org/10.4103/joacp.JOACP_343_20.
[4] K. Zhang, M. Rashid-Kolvear, R. Waseem, M. Englesakis, F. Chung. Virtual preoperative assessment in surgical patients: A systematic review and meta-analysis. J Clin Anesth. 2021;75:110540. https://doi.org/10.1016/j.jclinane.2021.110540
[5] G. Gibas, M. Liebisch, C. Eichenberg, V.T. Krenn, A. Sallakhi, S.E. Benhebesse, et al. Preoperative anxiety after face-to-face patient assessment versus preanaesthesia telemedicine (PANTEM) in adults: a randomised clinical trial. Wien Med Wochenschr. 2024;174(7-8):133-139. https://doi.org/10.1007/s10354-022-00937-y.
[6] P. Maurya, R. Gupta, S. Mishra, S. Bharati, N. Gupta, R. Garg, et al. The Non-inferiority of Telemedicine in Pre-anesthesia Clinic at a Tertiary Cancer Care Center: A Randomized Study. Cureus. 2025;17(2):e78596. https://doi.org/10.7759/cureus.78596.
[7] B.T. van Hoorn, D.J. Tromp, R.C.M. van Rees, L.X. van Rossenberg, H.K. Cazemier, M. van Heijl, et al. Effectiveness of a digital vs face-to-face preoperative assessment: A randomized, noninferiority clinical trial. J Clin Anesth. 2023;90:111192. https://doi.org/10.1016/j.jclinane.2023.111192.
[8] A. Roche, M. Simon, H. Bouaziz, M. Poussel, F. Sirveaux, I. Adam, et al. Quality of Preanesthesia Teleconsultation: The TELECAM Randomized Controlled Trial. Telemed J E Health. 2024;30(8):e2300-e2310. https://doi.org/10.1089/tmj.2024.0027.
[9] E. Morau, T. Chevallier, C. Serrand, M. Perin, Y. Gricourt, P. Cuvillon. Teleconsultation compared with face-to-face consultation in the context of pre-anesthesia evaluation: TELANESTH, a randomized controlled single-blind non-inferiority study. J Clin Anesth. 2024;92:111318. https://doi.org/10.1016/j.jclinane.2023.111318.
[10] T. Oliveira Hashiguchi. Bringing health care to the patient: an overview of the use of telemedicine in OECD countries. OECD Health Working Papers. 2020;(116). Paris: OECD Publishing. https://doi.org/10.1787/8e56ede7-en.
[11] C.L. Snoswell, G. Chelberg, K.R. De Guzman, H.H. Haydon, E.E. Thomas, L.J. Caffery, et al. The clinical effectiveness of telehealth: A systematic review of meta-analyses from 2010 to 2019. J Telemed Telecare. 2023;29(9):669-684. https://doi.org/10.1177/1357633X211022907.
[12] C. Doyle, L. Lennox, D. Bell. A systematic review of evidence on the links between patient experience and clinical safety and effectiveness. BMJ Open. 2013;3(1):e001570. https://doi.org/10.1136/bmjopen-2012-001570.
[13] W. Boulding, S.W. Glickman, M.P. Manary, K.A. Schulman, R. Staelin. Relationship between patient satisfaction with inpatient care and hospital readmission within 30 days. Am J Manag Care. 2011;17(1):41-8.
[14] M.J. Lozada, J.T. Nguyen, A. Abouleish, D. Prough, R. Przkora. Patient preference for the pre-anesthesia evaluation: Telephone versus in-office assessment. J Clin Anesth. 2016;31:145-8. https://doi.org/10.1016/j.jclinane.2015.12.040.
[15] C.H. Vacheron, C. Ferrier, F. Morau, A. Theissen, V. Piriou, P.Y. Carry, A. Friggeri. Pre-anaesthesia Telephone Consultation: A Safe Alternative for Anaesthesia Assessment in Case of Repeated Low or Intermediate Risk Surgeries: A Prospective Cohort Study. Turk J Anaesthesiol Reanim. 2023;51(3):207-212. https://doi.org/10.4274/TJAR.2022.221079.
[16] K. Ladin, T. Porteny, J.M. Perugini, K.M. Gonzales, K.E. Aufort , S.K. Levine, et al. Perceptions of Telehealth vs In-Person Visits Among Older Adults With Advanced Kidney Disease, Care Partners, and Clinicians. JAMA Netw Open. 2021;4(12):e2137193. https://doi.org/10.1001/jamanetworkopen.2021.37193.
[17] M. Hamaker, N. Hyman, K. Lodaria, H.B. Jackson, T.B. Sewell, K. Chen. Understanding Patients' Negative Experiences with Telehealth: A Content Analysis of Survey Data. J Patient Exp. 2024;11:23743735241240881. https://doi.org/10.1177/23743735241240881.
[18] J. Wienhold, L. Mösch, R. Rossaint, I. Kemper, M. Derwall, M. Czaplik, et al. Teleconsultation for preoperative evaluation during the coronavirus disease 2019 pandemic: A technical and medical feasibility study. Eur J Anaesthesiol. 2021;38(12):1284-1292. https://doi.org/10.1097/EJA.0000000000001616.
[19] D. Mayhew, V. Mendonca, B.V.S. Murthy. A review of ASA physical status - historical perspectives and modern developments. Anaesthesia. 2019;74(3):373-379. https://doi.org/10.1111/anae.14569.
[20] L.E. Tollinche, G. Yang, K.S. Tan, R. Borchardt. Interrater variability in ASA physical status assignment: an analysis in the pediatric cancer setting. J Anesth. 2018;32(2):211-218. https://doi.org/10.1007/s00540-018-2463-2.
[21] A. De Cassai, A. Boscolo, T. Tonetti, I. Ban, C. Ori. Assignment of ASA-physical status relates to anesthesiologists' experience: a survey-based national-study. Korean J Anesthesiol. 2019;72(1):53-59. https://doi.org/10.4097/kja.d.18.00224.
[22] R. Jacqueline, S. Malviya, C. Burke, P. Reynolds. An assessment of interrater reliability of the ASA physical status classification in pediatric surgical patients. Paediatr Anaesth. 2006;16(9):928-31. https://doi.org/10.1111/j.1460-9592.2006.01911.x.
[23] C.X.W. Kwa, J. Cui, D.Y.Z. Lim, Y.E. Sim, Y. Ke, H.R. Abdullah. Discordant American Society of Anesthesiologists Physical Status Classification between anesthesiologists and surgeons and its correlation with adverse patient outcomes. Sci Rep. 2022;12(1):7110. https://doi.org/10.1038/s41598-022-10736-5.
[24] M.A. Shebl, E. Toraih, M. Shebl, A.M. Tolba, P. Ahmed, H.S. Banga, et al. Preoperative anxiety and its impact on surgical outcomes: A systematic review and meta-analysis. J Clin Transl Sci. 2025;9(1):e33. https://doi.org/10.1017/cts.2025.6.
[25] J.P. Gouin, J.K. Kiecolt-Glaser. The impact of psychological stress on wound healing: methods and mechanisms. Immunol Allergy Clin North Am. 2011;31(1):81-93. https://doi.org/10.1016/j.iac.2010.09.010.
[26] J. Xing, C. Gong, B. Wu, Y. Li, L. Liu, P. Yang, et al. Effect of an educational video about ERAS on reducing preoperative anxiety and promoting recovery. Heliyon. 2023;9(10):e20536. https://doi.org/10.1016/j.heliyon.2023.e20536.
[27] A.M. Kaynar, N. Zharichenko, A.D. Wasan, J.E. Chelly. Telemedicine-Based Digital Cognitive Behavioral Intervention for Perioperative Anxiety and Depression for Total Knee Arthroplasty. J Pain Relief. 2023;12(9):1000005.
[28] M.N. Ozbek, E. Seyhan Ak. The Effect of Preoperative Tele-nursing Counseling on Anxiety and Patient Satisfaction in Day Surgery: A Randomized Controlled Trial. J Perianesth Nurs. 2025;40(4):852-860. https://doi.org/10.1016/j.jopan.2024.09.006.
[29] D.M. Ford, L. Budworth, R. Lawton, E.A. Teale, D.B. O'Connor. In-hospital stress and patient outcomes: A systematic review and meta-analysis. PLoS One. 2023;18(3):e0282789. https://doi.org/10.1371/journal.pone.0282789.
[30] Y. Tian. A review on factors related to patient comfort experience in hospitals. J Health Popul Nutr. 2023;42(1):125. https://doi.org/10.1186/s41043-023-00465-4.
[31] M. Sewell, M. Mohammadi, M. Kilbourne, G. Grunkemeier, P. Schipper, J. Doberne, et al. Extending the Reach of Thoracic Surgical Oncology With Telehealth. Ann Thorac Surg Short Rep. 2025;3(4):1166-1170. https://doi.org/10.1016/j.atssr.2025.04.003.
[32] E. Wolgemuth, J. Glackin, A.B. Linquist, J. Dorman, E. Somanath, M. Canale, E. Rauch. Implementation of a Preanesthetic Telehealth Visit to Reduce Day-of-Surgery Cancellations. J Perianesth Nurs. 2025;40(2):265-269. https://doi.org/10.1016/j.jopan.2024.05.022.
[33]T. Urbonas, A.S. Lakha, E. King, S. Pepes, C. Ceresa, V. Udupa, et al. The safety of telemedicine clinics as an alternative to in-person preoperative assessment for elective laparoscopic cholecystectomy in patients with benign gallbladder disease: a retrospective cohort study. Patient Saf Surg. 2023;17(1):23. https://doi.org/10.1186/s13037-023-00368-7.
[34] K. Mendis, V.P. Puligundla, M. Rosenzweig, M. Coffel, J. Geracitano, S. Khairat. The Impact of Telehealth on Cost and Time Efficiency for Patients With Disabilities During Nonemergency Encounters: A Scoping Review. Perm J. 2026;30(2):93-101. https://doi.org/10.7812/TPP/25.044.
[35] N.J. Elbert, H. van Os-Medendorp, W. van Renselaar, A.G. Ekeland, L. Hakkaart-van Roijen, H. Raat, et al. Effectiveness and cost-effectiveness of ehealth interventions in somatic diseases: a systematic review of systematic reviews and meta-analyses. J Med Internet Res. 2014;16(4):e110. https://doi.org/10.2196/jmir.2790.
[36] B. Delgoshaei, M. Mobinizadeh, R. Mojdekar, E. Afzal, J. Arabloo, E. Mohamadi. Telemedicine: A systematic review of economic evaluations. Med J Islam Repub Iran. 2017;31:113. https://doi.org/10.14196/mjiri.31.113.
[37] A. Gentili, G. Failla, A. Melnyk, V. Puleo, G.L.D. Tanna, W. Ricciardi, et al. The cost-effectiveness of digital health interventions: A systematic review of the literature. Front Public Health. 2022;10:787135. https://doi.org/10.3389/fpubh.2022.787135.
[38] C.L. Snoswell, M.L. Taylor, T.A. Comans, A.C. Smith, L.C. Gray, L.J. Caffery. Determining if Telehealth Can Reduce Health System Costs: Scoping Review. J Med Internet Res. 2020;22(10):e17298. https://doi.org/10.2196/17298.
[39] N.D. Eze, C. Mateus, T. Cravo Oliveira Hashiguchi. Telemedicine in the OECD: An umbrella review of clinical and cost-effectiveness, patient experience and implementation. PLoS One. 2020;15(8):e0237585. https://doi.org/10.1371/journal.pone.0237585.
[40] M.J. Page, J.E. McKenzie, P.M. Bossuyt, I. Boutron, T.C. Hoffmann, C.D. Mulrow, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. https://doi.org/10.1136/bmj.n71.
[41] J. Wetterslev, J.C. Jakobsen, C.Gluud. Trial Sequential Analysis in systematic reviews with meta-analysis. BMC Med Res Methodol. 2017;17(1):39. https://doi.org/10.1186/s12874-017-0315-7.
[42] J. Cohen. Statistical Power Analysis for the Behavioral Sciences. 2nd ed., Lawrence
Descargas
Publicado
Cómo citar
Número
Sección
Licencia
Derechos de autor 2026 José Miguel Sampaio, Arthur Henrique de Lima, Ana Clara Mattos, Maria Eduarda Braga, Lucas de Souza, Leandro de Sousa, Murilo do Nascimento
Esta obra está bajo una licencia internacional Creative Commons Atribución 4.0.
Você tem o direito de:
- Compartilhar — copiar e redistribuir o material em qualquer suporte ou formato para qualquer fim, mesmo que comercial.
- Adaptar — remixar, transformar, e criar a partir do material para qualquer fim, mesmo que comercial.
- O licenciante não pode revogar estes direitos desde que você respeite os termos da licença.
De acordo com os termos seguintes:
- Atribuição — Você deve dar o crédito apropriado , prover um link para a licença e indicar se mudanças foram feitas . Você deve fazê-lo em qualquer circunstância razoável, mas de nenhuma maneira que sugira que o licenciante apoia você ou o seu uso.
- Sem restrições adicionais — Você não pode aplicar termos jurídicos ou medidas de caráter tecnológico que restrinjam legalmente outros de fazerem algo que a licença permita.
