Digital Versus in-Person Pre-Anaesthetic Assessment and Postoperative Outcomes in Low-Risk Patients: A Protocol for a...

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. We hypothesise that digital pre-anaesthetic assessment modalities will be associated with low rates of major postoperative complications in selected low-risk patients. This protocol describes a single-centre study with retrospective data collection including adult patients scheduled for elective otorhinolaryngologic, oral or maxillofacial surgery at Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark. Patients underwent preoperative assessment using one of three modalities: in-person consultation (2019-2020), EHR review (2021-2022) or video consultation (2024-2025). The primary outcome is a composite of major postoperative complications within 30 days, including all-cause mortality, admission to the intensive care unit, bleeding requiring transfusion, infection requiring antibiotics, or hospital readmission. Secondary outcomes include number of days spent hospitalised within 30 days after surgery, changes in anaesthesia plan, airway management modifications, delay in surgical start time, intubation attempts and same-day cancellations. Associations between assessment modality and dichotomous outcomes will be examined using multivariable generalised linear models with a log-link function, adjusted for prespecified covariates. Sensitivity analyses will include inverse probability weighting and win ratio analysis. This single-centre cohort study will examine whether digital pre-anaesthetic assessment strategies, such as video consultation and EHR review, are associated with differences in major postoperative complications compared with in-person assessment. The findings may inform the implementation of patient-centred, resource-efficient preoperative assessment strategies within the Danish healthcare system and similar international settings.