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Diagnostic accuracy of anesthesiology evaluation timing: the 'One-Stop Anesthesia' in pediatric day-surgery
Giovanni Mangia1, Paola Presutti, Adriana Antonucci
1Department of Anaesthesiology, San Camillo Hospital, Rome, Italy. mangia.giovanni@fastwebnet.it
Insights
Optimizing anesthetic evaluation timing in pediatric day-surgery significantly reduces hospital visits. This diagnostic accuracy study demonstrates a cost-effective approach to preoperative patient assessment, improving healthcare efficiency.
Area of Science:
- Pediatric Anesthesiology
- Health Services Research
- Diagnostic Accuracy Studies
Background:
- Pediatric day-surgery patients are categorized into healthy and those requiring medical evaluation.
- Preoperative assessment timing is crucial for efficient patient management.
Purpose of the Study:
- To assess the timing efficacy of anesthetic evaluation in pediatric day-surgery using a diagnostic accuracy study.
- To reduce hospital visits for patients with negative medical histories.
Main Methods:
- Clinical data from pediatric surgeons were reviewed by an anesthetist.
- Anesthesiology evaluation timing was determined: same-day (One-Stop Anesthesia) or pre-admission clinic.
- Bayesian Statistical Analysis was used to examine data from 332 children.
Main Results:
- The 'One-Stop Anesthesia' group showed 87.4% true positives and 1.2% false positives.
- The Pre-Admission Clinic group had 9% true negatives and 2.4% false negatives.
- High diagnostic accuracy metrics were achieved: sensitivity 97.3%, specificity 88.2%, overall accuracy 96.4%.
Conclusions:
- Timing preoperative anesthesiologist evaluation effectively reduced hospital visits by 88%.
- This strategy proved cost-effective, lowering direct and indirect healthcare costs.
- Optimized preoperative assessment enhances efficiency in pediatric day-surgery.
Objective:
Assessing timing efficacy of anesthetic evaluation in pediatric day-surgery by a diagnostic accuracy study.
Aim:
Lowering hospital visits in patients with negative medical history.
Background:
Pediatric patients scheduled for day-surgery procedures can be categorized, according to their history, in two groups. One, the largest, includes healthy patients and the other includes those with medical conditions that necessitate further evaluation.
Materials And Methods:
Clinical data are collected by the pediatric surgeons of our department and reviewed by an anesthetist who then selects the timing of anesthesiology evaluation, which will take place in the same day of the procedure (One-Stop Anesthesia), or some days before it, in a dedicated setting (Pre-Admission Clinic). In 2008, 332 children, older than 12 months, screened by that method, underwent surgical procedures in general anesthesia.
Results:
Our data were examined using Bayesian Statistical Analysis. In the 'One-Stop Anesthesia' group, true positive were 290 (87.4%) and false positive 4 (1.2%). Of the 38 patients assessed by our Pre-Admission Clinic, true negative were 30 (9%) and false negative 8 (2.4%). Sensibility (97.3%), specificity (88.2%), positive predictive value (98.6%), negative predictive value (78.9%), diagnostic accuracy (96.4%), likelihood positive (8.3), and likelihood negative (0.03) were calculated.
Conclusions:
Timing the preoperative anesthesiologist's evaluation avoided 88% of hospital visits, usually to the Pre-Admission Clinic, and thus, it was cost effective, reducing direct and indirect costs of healthcare providers.
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