Digital Versus in‐Person Pre‐Anaesthetic Assessment and Postoperative Outcomes in Low‐Risk Patients: An Observational Study

BACKGROUND: Pre-anaesthetic assessment is essential for identifying perioperative risk and optimising patient safety. Digital alternatives, including video consultation and structured electronic health record (EHR) review, may improve efficiency, but comparative evidence regarding postoperative safety remains limited. This study aimed to evaluate postoperative outcomes across pre-anaesthetic assessment through EHR review, video consultation, and in-person assessment. We hypothesised that patients selected for digital pre-anaesthetic assessment within a structured triage system would have similar low 30-day rates of major postoperative complications compared with in-person assessment. METHODS: We conducted a single-centre cohort study at Copenhagen University Hospital-Rigshospitalet, Denmark, including adult patients undergoing elective otorhinolaryngologic, oral, or maxillofacial surgery. Patients underwent pre-anaesthetic assessment by one of three modalities: in-person consultation, EHR review, or video consultation. The primary outcome was a composite of major postoperative complications within 30 days, including all-cause mortality, intensive care unit admission, bleeding requiring transfusion, infection requiring antibiotics, or hospital readmission. A multivariable generalised linear model with a log-link function was used to estimate adjusted relative risks (RRs) with 95% confidence intervals (CIs). RESULTS: A total of 862 patients were included (in-person n = 300; EHR review n = 300; video consultation n = 262). Patients in the in-person group were older and had a higher comorbidity burden. Using in-person as reference, neither video consultation nor EHR review showed a significantly different risk of major postoperative complications. Hospital readmission was lower in both digital groups in pairwise comparisons with the in-person group. Results were consistent across sensitivity analyses, including inverse probability weighting and win ratio analysis. CONCLUSION: Patients selected for digital pre-anaesthetic assessment had low rates of major postoperative complications. However, substantial baseline differences between groups indicate that assessment modality was strongly linked to clinical triage and baseline patient risk, thereby limiting direct comparison between pathways. Thus, these findings should not be interpreted as evidence of equivalence or non-inferiority between pathways. EDITORIAL COMMENT: Preoperative anesthesia assessment is managed in different ways, based on local preferences logistics and resource availability, and perceived perioperative risk for complications. This study assessed this process for planned surgery in section at a university hospital. Those during a number of recent years chosen for in-person preoperative assessment (for any reason) were compared to those who had some form of digital assessment chosen by the anesthesia personnel. The selection process for in-person preoperative assessment seemed to identify those who had a higher chance of a major postoperative complication.