Assessment of Anesthesia Consultation Delays and Their Impact on Scheduled Surgery

  


    
Impacts    of Delay 

    
Description    and Interpretation 

  

  


    
Mild Discomfort 

    
Nineteen patients reported    mild discomfort due to the delay, which may include concerns or minor    inconveniences. Although mild, discomfort can affect the patient's experience    and requires special attention to minimize future delays. 

  

  


    
No Particular Impact 

    
Forty patients did not report    any specific impact due to the delay, suggesting that delays did not have    significant consequences for their experience or health. Delays do not always    have serious consequences, but it is essential to avoid them as much as possible    for the well-being of patients. 

  

  


    
Increased Stress 

    
Two cases experienced    increased stress due to the delay, involving significant health-related    concerns. Increased stress can have implications for patients' mental and    emotional health, highlighting the importance of reducing delays. 

  

Table 5: Impacts of Delay.

• Impacts of Delay

Mild Discomfort (19 cases): Nineteen patients reported mild discomfort due to the delay, which could include concerns or minor inconveniences. While these discomforts are relatively mild, they can impact the patient's experience, highlighting the importance of minimizing future delays. No Particular Impact (40 cases): In 40 cases, patients did not report any specific impact due to the delay, indicating that the delays did not have significant consequences for their experience or health. Nevertheless, it remains essential to minimize delays for the overall well-being of patients. Increased Stress (2 cases): Two cases experienced increased stress due to the delay, which was related to significant health-related concerns. Increased stress can have implications for patients' mental and emotional well-being, underscoring the importance of reducing delays to mitigate such stress.

Discussion

CPA-Surgery Delays

The study observed varying delays in our sample, emphasizing the importance of understanding the factors influencing these delays. Variations in delays based on surgical specialty and the type of surgery highlight the complexity of preoperative planning. The results suggest that a more targeted delay management approach tailored to each case's specificity could enhance overall preoperative efficiency.

Rationalizing Preoperative Testing

The study examined preoperative investigation

trends and frequencies in our medical setting, shedding light on current practices and their alignment with existing guidelines and recommendations [3]. The analysis provided valuable insights into the justification and necessity of preoperative laboratory tests. The most commonly requested tests included complete blood count (NFS), ionograms, and Electrocardiograms (ECG), indicating a cautious approach to preoperative assessments, focusing on hematology, coagulation capacity, lung function, and cardiac function.

These findings align with the broader medical literature's discussion on the value and necessity of systematic preoperative laboratory tests. Many renowned studies and reports have questioned the conventional practice of extensive preoperative tests, emphasizing the need for a more selective, evidence-based approach [4-7].

The American Society of Anesthesiologists' (ASA) Preoperative Assessment Workgroup, in its 2002 practice advisory, recommended selective tests based on clinical assessment and risk evaluation instead of a systematic battery of tests to reduce unnecessary consultations, delays, and surgery day cancellations, streamlining the preoperative process and reducing costs [8].

Furthermore, studies, such as Chung et al. (2009), showed that eliminating certain preoperative tests in outpatient surgery did not lead to adverse postoperative outcomes. These discussions also consider factors like sensitivity, specificity, disease prevalence, and cost-effectiveness. Clinical relevance, sensitivity, and specificity of tests, along with disease prevalence, influence screening test utility [9].

Preoperative tests should be ordered based on each patient's history and physical examination to confirm disease suspicion, optimize patient management, decide on anesthetic management, and predict perioperative complications. The incidence of abnormal tests is very low in ASA-I and ASA-II patients requiring elective surgery, and patients rarely require changes in peri-anesthetic management due to abnormal test results. Routine tests, in addition to the increasing cost of surgical care, offer no benefits to these patients. Test results based on each patient's clinical condition will provide significant financial benefits without compromising patient safety and healthcare quality [6].

Reasons for Delays

Identified reasons for delays, such as scheduling issues, highlight organizational challenges that hospitals may face in managing surgical schedules. Better coordination and meticulous planning are necessary to reduce these delays and enhance preoperative efficiency.

Impacts of Delays

The impacts of delays on patients vary case by case, with the

majority of patients reporting no significant impact. Nevertheless, considering patients' emotional and physical well-being, measures can be taken to minimize any discomfort related to delays, even if it is minimal.

This study emphasizes the need for a holistic approach to managing delays between the Pre-Anesthetic Consultation (PAC) and surgery. Better communication, effective coordination between medical and surgical teams, and specific attention to patient well-being can optimize delays and ensure a positive experience for all patients, regardless of the type of surgery and medical context. This study provides a solid foundation for future initiatives aimed at improving the preoperative process and ensuring high-quality care [10].

Comparison with Previous Studies and Contextualization

Lack of Similar Studies: In our institution, the requirement for Pre-anesthetic

Consultation (PAC) dates back to 1995, and we were the first in Morocco to introduce it. An extensive scrutiny of the existing scientific literature has revealed a conspicuous absence of congruent investigations, there by accentuating the innovative character of our research endeavors concerning the temporal intervals between PAC and surgical interventions. This distinctive circumstance primarily emanates from the institution-specific prerequisites and guidelines governing our hospital. This distinct scenario engenders a series of intricate challenges. Notably, our clinical practice is characterized by a substantial cohort of patients awaiting surgical procedures, notwithstanding the prompt completion of pre-anesthesic evaluations upon the initial surgical indication by the attending surgeon. Consequently, this intricate clinical landscape occasionally engenders protracted delays between the completion of PAC and the actual surgical intervention, there by invoking pertinent questions regarding the procedural validity and clinical utility of these consultations.

Implications of Previous Studies: Several previous studies have addressed aspects

related to postoperative outcome determinants, the efficiency of complementary tests, and the consequences of surgical delays, providing valuable insights into the significance and impact of our own findings.

Temporal Factors in Postoperative Outcomes

Examining temporal factors in postoperative outcomes is essential to understand the impact of delays between the pre-anesthesia consultation (PAC) and surgery on patients' health. Several previous studies have provided valuable insights into how the timing of surgery can influence perioperative and postoperative results [11-14].

Variations in Surgical Delays and Consequences

A study conducted by V. Ho, B. H. Hamilton, and L. L. Roos examined fvariations in hip fracture surgery delays in the United States and Canada, showing that longer delays did not necessarily lead to more unfavorable postoperative outcomes in terms of hospital length of stay or mortality [11]. However, this observation cannot be generalized to all surgical procedures, as each type of surgery may have specific timing requirements.

In another study by Roy H. Lan and Atul F. Kamath, the results revealed that preoperative evaluations closer to the surgery date were associated with shorter hospital stays, less frequent admissions to the intensive care unit, and fewer major complications for patients undergoing total hip arthroplasty [12]. However, this study has limitations, including its small sample size and being conducted in a single institution.

Impact of Waiting Time in Neoplastic Surgery

A study conducted by Brenkman et al. examined the waiting time between the diagnosis of curable gastric cancer and treatment, showing that even beyond the recommended 5-week period, a longer delay did not have a significant impact on the survival of patients undergoing gastrectomy [13]. However, these results may not necessarily be generalized to other types of cancer, and the reasons for treatment delays may vary.

Specific Temporal Factors and Psychological Consequences

Scheduling issues, waiting for specialist evaluations, and delays in the results of complementary examinations have been identified as reasons for delays between the PAC and surgery. Previous studies have shown that preoperative medical evaluations closer to the surgery date can reduce preoperative anxiety in patients [12,14].

Implications for Preoperative Delay Management

Considering the results of the studies and the literature review, several practical implications for the management of preoperative delays should be considered. It is important to improve coordination and communication among clinical services to minimize unnecessary delays. Additionally, structured preoperative medical evaluations can be beneficial in better managing underlying medical conditions and reducing preoperative anxiety [15]. Personalizing complementary examinations based on each patient's specific needs is essential to optimize resources while providing high-quality care. Audits and clinician awareness interventions can also help reduce the overuse of certain preoperative tests [16]. It is crucial to recognize that these conclusions may vary depending on the types of surgeries and patient populations, and further research is needed to refine our understanding of this complex issue.

Conclusion

Our study delves into preoperative delays between the pre-anesthetic consultation (CPA) and surgery and the rationality of preoperative laboratory testing, shedding light on current practices and their implications. The findings underline the need for a patient-centered approach to preoperative laboratory tests and surgical scheduling. Selective testing, improved communication and coordination, and a focus on patient well-being are pivotal in optimizing the preoperative process and enhancing patient care. This research is a significant step toward achieving efficient, cost-effective, and patient-focused preoperative practices. The study's implications and recommendations have the potential to influence surgical practice and healthcare systems, ultimately benefiting patients and healthcare providers alike.

Author Statements

As per international standard or university standard written ethical approval has been collected and preserved by the author(s).

Author Contributions

Wiam EL JELLOULI, Khalil ABOU ELALAA: Conception, patient enrolment, and interpretation. All authors contributed to literature review, final draft writing, and critical revision. All the authors have participated sufficiently in this work, take public responsibility for the content, and have made substantial contributions to this research.

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