Operational impact and workflow optimization of a virtual pre-anesthesia clinic: a retrospective observational study

Pre-anesthesia clinics (PAC) are essential for optimizing patient care and reducing same-day surgical cancellations. Traditional physical clinics face challenges in capacity and patient convenience, and virtual pre-anesthesia clinic (VPAC) models have emerged internationally as a potential solution. This study evaluates the operational impact of a hybrid VPAC implemented at a tertiary care center in Saudi Arabia. We conducted a retrospective observational study comparing two periods: a baseline period (2019) using a traditional physical PAC and a post-intervention period (2024) following implementation of a hybrid VPAC workflow. Elective cases under anesthesia care were compared (8,746 in 2019; 11,871 in 2024) after exclusion of emergency cases and procedures without anesthesia attendance. The primary outcome was the rate of avoidable, system-attributable anesthesia-related same-day cancellations (those due to incomplete preoperative workup). Secondary outcomes included patient volumes across triage pathways and the risk profile of the surgical population. The avoidable anesthesia-related cancellation rate decreased from 0.297% (26/8,746) in 2019 to 0.101% (12/11,871) in 2024, a 66.0% relative reduction (relative risk 0.34; 95% CI 0.17–0.67; p = 0.002). In 2024, the VPAC workflow managed 12,857 unique patients: 218 (1.7%) via Pathway 1 (Triage tele-clinic), 611 (4.8%) via Pathway 2 (Virtual PAC), and 12,028 (93.6%) via Pathway 3 (Physical PAC). The surgical case mix changed significantly between periods ( p < 0.001), and the risk profile shifted toward higher acuity (ASA III+ increased from 23.6% to 26.4%, p < 0.001). The implementation of a hybrid VPAC workflow was associated with a significant reduction in avoidable anesthesia-related same-day cancellations, even as surgical volume and patient acuity increased. Although most patients continued to require physical assessment, the virtual pathways provided efficient triage and clearance for a defined subset of patients, consistent with international literature.