Anesthetic and Perioperative Risk Assessment Before Programmed Surgery: Anesthetic Teleconsultation Versus Face-to-face Anesthesia Consultation.

Study Overview
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Brief Summary
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The anesthesia safety decree made it compulsory in 1994 to carry out a pre-anesthesia consultation before any operative or interventional act. With the inclusion of telemedicine in the Public Health Code then the publication of Addendum 6 in 2018 and finally the derogatory decree in March 2020, it is possible to perform and bill for pre-anesthesia consultation via telemedicine. The consultation is always followed by a pre-anesthetic visit upon admission of the patient the day before or the day of the operation to verify the information recorded during the consultation and the patient's state of health. This identifies elements omitted during the pre-anesthesia consultation (face-to-face or remotely) and reduces the risks of potential postponement. The study investigators hypothesize that there would be no difference in the quality of the information given, the collection of medical, paramedical and medication elements and the evaluation of the operative risk in anesthesia consultation via teleconsultation versus face-to-face. The critical points are the medication reconciliation of the patient's treatments, the overall assessment of the operative risk and anticipated difficulty of access to the airways (mouth opening: ≥ or <35 mmm).

Official Title
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Anesthetic and Perioperative Risk Assessment Before Programmed Surgery: Anesthetic Teleconsultation Versus Face-to-face Anesthesia Consultation.

Conditions
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Telemedicine, Anesthesia, Consultation, Remote

Intervention / Treatment
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* Other: Face-to-face anesthesia consultation
* Other: Remote anesthesia consultation


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: The patient must have given their free and informed consent and signed the consent form The patient must be a member or beneficiary of a health insurance plan Patient with scheduled surgical intervention (outpatient or hospitalization) at the Nîmes University Hospital requiring a preoperative anesthesia consultation. Patient with computer equipment at home allowing the use of the Téléo software (computer equipment with web cam, audio and microphone or smartphone). Exclusion Criteria: The subject is participating in a category 1 interventional study, or is in a period of exclusion determined by a previous study The subject refuses to sign the consent It is impossible to give the subject informed information The patient is under safeguard of justice or state guardianship Patient who has already had an anesthesia consultation for surgery within the previous 6 months. Emergency or radiology and / or interventional surgery (eg. gastroscopy, biopsy under scanner, etc.).

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Teleconsultation<br> | Other: Remote anesthesia consultation<br>* Anesthesia consultation is carried out in teleconsultation via the Téléo web application (audio and video) at the patient's home on a computer or smartphone. This application allows sending and receiving documents identical to those during the face-to-face consultation.<br>|
| Control group<br> | Other: Face-to-face anesthesia consultation<br>* The anesthesia consultation is carried out in person in accordance with the usual management.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Elevated American Society of Anesthesiologists (ASA) score in each group | Yes/no for if score=3-4 | anesthesia consultation = 1 week to 3 months after inclusion | 
| Elevated American Society of Anesthesiologists (ASA) score in each group | Yes/no for if score=3-4 | pre-anesthetic visit = 9 days to 3 months+7 days after inclusion | 
| Difficulty in accessing airways each group | Yes/no for mouth opening ≥35 mm | anesthesia consultation = 1 week to 3 months after inclusion | 
| Difficulty in accessing airways each group | Yes/no for mouth opening ≥35 mm | pre-anesthetic visit = 9 days to 3 months+7 days after inclusion | 
| Medication conciliation performed during the anesthesia consultation each group | Yes/no: adaptations of selected therapies: anticoagulants, anti-aggregants, anti-hypertension, antidiabetics | pre-anesthetic visit = 9 days to 3 months+7 days after inclusion | 
| Medication conciliation performed during the anesthesia consultation each group | Yes/no: adaptations of selected therapies: anticoagulants, anti-aggregants, anti-hypertension, antidiabetics | anesthesia consultation = 1 week to 3 months after inclusion | 
| Difference between groups in composite score of above outcomes (elevated ASA score, difficulty accessing airways and medication conciliation) | Difference in number of yes/no answers at anesthesia consultation compared to pre- anesthetic visit | pre-anesthetic visit = 9 days to 3 months+7 days after inclusion | 
| Difference between groups in composite score of above outcomes (elevated ASA score, difficulty accessing airways and medication conciliation) | Difference in number of yes/no answers at anesthesia consultation compared to pre- anesthetic visit | anesthesia consultation = 1 week to 3 months after inclusion | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of canceled surgeries in each group | Yes/no surgery not performed on the scheduled day and / or postponed > 2 days | Day 2 after pre-anesthetic visit | 
| Reason for cancellation of surgery | Description noted in electronic clinical report form | Day 2 after pre-anesthetic visit | 
| Number of delayed surgeries in each group | Yes/no surgery not performed on the scheduled day and / or postponed ≤ 2 days | Day 2 after pre-anesthetic visit | 
| Reason for delayed surgery | Description noted in electronic clinical report form | Day 2 after pre-anesthetic visit | 
| Complication rate in perioperative and immediate postoperative period | % patients with a complication | 2 days post-operatively | 
| Rate of anesthesia consultation rescheduling in each group | Number of consultations rescheduled | 2 days after pre-anesthetic visit | 
| Reason for rescheduling | Description noted in electronic clinical report form | 2 days after pre-anesthetic visit | 
| Global patient satisfaction | satisfaction on a visual analog scale 0-10 | pre-anesthetic visit = 9 days to 3 months+7 days after inclusion | 
| Satisfaction on the delivery of the information | 6-item custom questionnaire completed on a Likert 0 - 5 scale for all patients plus 6 questions specific for control group and 7 for intervention group | pre-anesthetic visit = 9 days to 3 months+7 days after inclusion | 
| Ecological impact of the consultation in each group | Carbon impact (CO2 generated) of number of km between the patient's home and the hospital | pre-anesthetic visit = 9 days to 3 months+7 days after inclusion | 
| Economic impact of the consultation in each group | Cost in euros of cost of travel and time at work missed | pre-anesthetic visit = 9 days to 3 months+7 days after inclusion | 
| Rate of presence of the usual treatment prescription | Yes/no | During the anesthesia consultation = 1 week to 3 months after inclusion | 
| Rate of presence of the completed health questionnaire | Yes/no | During the anesthesia consultation = 1 week to 3 months after inclusion | 
| Rate of presence of specialist consultation reports less than 1 year old | Yes/no | During the anesthesia consultation = 1 week to 3 months after inclusion |