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PaedIatric caNcelation ratEs And PerioPerative clinicaL Evaluation (PINEAPPLE): A UK Prospective Multi-Center
Tom Bennett1, Hannah Lewis2, Catherine Riley3
1University Hospital Southampton, Southampton, UK.
Insights
Pediatric preassessment significantly reduced patient anxiety before general anesthesia, though it did not impact cancelation rates. Standardizing preassessment services nationally is recommended to maximize benefits and improve child surgical outcomes.
Area of Science:
- Pediatric Anesthesiology
- Perioperative Medicine
- Healthcare Quality Improvement
Background:
- Pediatric preassessment is a recommended practice for children undergoing general anesthesia.
- It holds potential for enhancing patient safety and organizational quality outcomes.
- This study investigates the current state and impact of preassessment in pediatric anesthesia.
Purpose of the Study:
- To determine the proportion of children receiving preassessment before general anesthesia.
- To analyze the formats of preassessment delivery.
- To evaluate the impact of preassessment on outcomes like on-the-day cancelations and patient anxiety.
Main Methods:
- A multi-center prospective observational cohort study was conducted in the UK.
- Data were collected from 96 hospitals involving 6818 children aged 1-16 years.
- Participants were recruited via the Pediatric Anesthetic Trainee Research Network.
Main Results:
- 60.1% of children (4082) received preassessment, with significant variation in delivery methods, mostly nurse-led.
- Preassessment was associated with a significant reduction in perioperative anxiety (12.0% vs. 16.5%, p < 0.001).
- No statistically significant difference in overall cancelation rates was observed; common reasons included intercurrent illness and anxiety.
Conclusions:
- Reducing patient anxiety through preassessment can improve surgical outcomes.
- Screening calls before surgery may prevent cancelations due to illness.
- National standardization of pediatric preassessment is needed to optimize its benefits.
Background:
Pediatric preassessment is recommended for all children undergoing general anesthesia. It has the potential to improve safety and quality outcomes for both the patient and the organization.
Aims:
This study aimed to establish the proportion of children who underwent preassessment before general anesthesia, the format of that preassessment, and the impact of preassessment on outcomes such as on-the-day cancelation, and patient anxiety.
Methods:
This multi-center prospective observational cohort study outlines preassessment delivery in the UK and its effect on outcome. Invitation to participate was via Pediatric Anesthetic Trainee Research Network. Data collected included demographic data, details of the patient's preassessment, and their outcome.
Results:
Data were verified from 96 hospitals on 6818 patients between 1 and 16 years old having elective procedures under general anesthetic. The proportion of children ≤ 16 years old who received preassessment was 60.1% (4082 children). There was a large variation in the delivery of preassessment with the majority being nurse-led. The perioperative journey of most children proceeded as planned (6454 patients, 94.6% of cases). There was a significant difference in the proportion of children with perioperative anxiety between those who did (12.0%, n = 482) and did not (16.5%, n = 438) have a preassessment (p < 0.001). Preassessment did not make a statistically significant difference to overall cancelation rates. The most common reasons for cancelation were intercurrent illness and anxiety. A greater proportion of procedures were delayed or canceled if anxiety was identified as a perioperative challenge: 20.8% (n = 191) compared to 3.6% (n = 210, p < 0.001).
Conclusion:
These data suggest that improved outcomes could be achieved through a reduction in anxiety. A service offering screening calls in the days before surgery could prevent on-the-day cancelation due to intercurrent illness. The priorities for preassessment in children require further clarification and standardization nationally to maximize the potential benefits from services.
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